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Long-term efficacy of alpha-interferon in beta-thalassemics with chronic hepatitis C
V Di Marco1, O Lo Iacono, P Almasio
1Cattedra di Medicina Interna (CLOPD), Istituto di Clinica Medica I, Università di Palermo, Italy.
Insights
Alpha-interferon therapy can achieve sustained remission for hepatitis C virus (HCV) infection in beta-thalassemia patients. Factors like non-advanced liver disease and HCV type influence treatment success.
Area of Science:
- Hepatology
- Virology
- Hematology
Background:
- Hepatitis C virus (HCV) infection frequently affects polytransfused individuals with beta-thalassemia major.
- Chronic HCV infection can lead to significant liver disease in this vulnerable population.
Purpose of the Study:
- To evaluate the long-term efficacy of alpha-interferon in treating chronic hepatitis C in beta-thalassemia patients.
- To determine the impact of HCV genotype and liver siderosis on treatment outcomes.
Main Methods:
- A cohort of 70 beta-thalassemia patients with chronic HCV infection received 12 months of recombinant alpha-interferon.
- Patients were monitored for at least 24 months post-therapy for biochemical and virologic markers.
- HCV genotyping and liver biopsy for siderosis assessment were performed.
Main Results:
- 40% of patients achieved normal aminotransferases and cleared HCV RNA, with a mean follow-up of 36.5 months.
- Sustained response was associated with the absence of cirrhosis, low liver iron, and non-1b HCV types.
- 9 out of 41 patients who initially did not normalize aminotransferases later cleared HCV RNA.
Conclusions:
- Alpha-interferon can induce sustained virologic and biochemical remission in beta-thalassemia patients with chronic HCV.
- Early treatment in patients with non-advanced liver disease and specific HCV types yields better outcomes.
- This therapy offers a viable option for managing HCV in this specific patient group.
Abstract:
Hepatitis C virus (HCV) infection is a common cause of liver disease among polytransfused thalassemics. We treated a cohort of subjects with beta-thalassemia major and chronic hepatitis C with alpha-interferon. The aims of the study were to assess the long-term biochemical and virologic efficacy of alpha-interferon and to evaluate the influence of HCV type and liver siderosis on the outcome of therapy. Seventy subjects (mean age, 14.1 years) with chronic HCV infection and abnormal aminotransferases received recombinant alpha-interferon for 12 months and were observed after therapy for at least 24 months. Sixty-three subjects (90%) were HCV-RNA positive at the start of therapy. HCV type 1b was found in 41 subjects (65.1%), non-1b types in 13 (20.6%), and mixed HCV types in 9 (14.3%). Liver biopsy showed cirrhosis in 11 subjects (15.7%) and siderosis grade 3-4 in 24 patients (34.2%). Three patients stopped therapy due to adverse events. Twenty-eight subjects (40%) had normal aminotransferases and had cleared HCV-RNA when last observed (mean follow-up, 36.5 months; range, 25 to 49 months). Of 41 patients who did not normalize aminotransferases, 9 had become HCV-RNA negative at the end of follow-up. The absence of cirrhosis, low liver iron content, and infection with non-1b HCV type were independently associated to complete sustained response upon multivariable analysis. In conclusion, alpha-interferon may induce a sustained virologic and biochemical remission of hepatitis in beta-thalassemic patients with chronic HCV infection and nonadvanced liver disease.