Lipid Profiles and Hepatitis C Viral Markers in HCV-Infected Thalassemic Patients

BACKGROUND/AIMS: The distribution of blood lipids, glucose and their determinants in thalassemic patients with chronic hepatitis C virus (HCV) infection has rarely been investigated. Thus, we aimed to investigate the relationship between both liver histologic findings and viral markers and serum lipids in thalassemic patients chronically infected with HCV. METHODS: We enrolled 280 polytransfused thalassemic patients with chronic hepatitis C. HCV viral load was determined using the Amplicor test. Genotyping was performed using genotype specific primers. Fasting serum lipid, glucose, ferritin and liver function enzyme concentrations were measured. A modified Knodell scoring system was used to stage liver fibrosis and to grade necroinflammatory activity. Perls' staining was used to assess hepatic siderosis. RESULTS: Just one subject had total cholesterol >200 mg/dL, and 7% had triglycerides >150 mg/dL. The mean high-density lipoprotein cholesterol (HDL-C) and glucose levels were 37 and 104 (97-111) mg/dL, respectively. Viral markers, liver histological findings and aminotransferase activity were not associated with serum lipid levels. Serum triglycerides, total cholesterol and ferritin were independent risk factors for impaired glucose tolerance or diabetes in these patients. CONCLUSIONS: The majority of the patients had blood lipid levels (with the exception of HDL) within the defined normal range; viral and liver histological factors do not appear to play a significant role in changing the levels of serum lipids or glucose in these patients.

Safety and efficacy of pegylated interferon alfa-2a for the treatment of hepatitis c in patients with major thalassemia

Hepatitis C virus [HCV] infection is the most common transfusion transmitted disease in poly-transfused patients worldwide. In this study we aimed to evaluate the effects of pegylated interferon alfa-2a [PEG-IFN A-2a] in reducing serum ALT and eradicating serum hepatitis C virus [HCV] RNA in HCV infected polytransfused thalassemic patients. A cohort of 51 HCV-RNA positive thalassemic patients were enrolled to our study and received 180 u,g PEG-IFN A-2a once-weekly for 48 weeks. The primary end point was sustained virological response [SVR]. The secondary outcome was normalization of ALT. Patient safety was assured by monthly, and if needed, weekly laboratory assessment and visits. Of 52 patients, 42 participants completed the treatment schedule. A sustained virological response [SVR] was attained in 22/51 [43%] cases. Among non-responders or relapsers to previous HCV antiviral therapy, 9/27 [33%] attained an SVR. Five patients died during treatment and 3 subjects discontinued the therapy because of adverse effects. Adverse events were generally mild, and laboratory abnormalities were rare. A course of 48-week PEG-IFN A-2a monotherapy is effective in eradicating HCV-RNA during treatment. But about one third of thalassemic patients would relapse within 6 months of treatment schedule completion, in whom combination therapy is needed

prevalence of thrombocytopenia in patients with chronic hepatitis B and C

Thrombocytopenia is a relatively common extrahepatic manifestation of hepatitis c,even in the absence of cirrhosis.Also, thrombocytopenia has been reported in chronic HBV infection. The aims of present study were to evaluate the prevalence of thrombocytopenia in chronic HCV and HBV infection in the absence of cirrhosis and to assess the relationship between HBV and HCV infection and frequency of thrombocytopenia. 438 patients [219 patients with chronic active hepatitis B and 123 inactive carriers of HBV and 96 patients with chronic HCV infection] were enrolled in this study. Thrombocytopenia was defined as platelet counts below 150,000/microl. The prevalence of thrombocytopenia was 17.7% in patients with chronic active hepatitis B and 10.6% in HBV inactive carriers, 13.3% in patients with chronic hepatitis C and 5.3% in control group. The prevalence of thrombocytopenia in chronic hepatitis B and C was significantly more than control group. These results in Iran, with 2-3 million people with chronic HBV infection and around 400,000 with chronic HCV infection shows that HBV and HCV infections, even in the absence of cirrhosis, may be two causes of thrombocytopenia

Rheumatoid case with HCV infection

A 46-year-old woman referred to our center due to abnormality in aminotransferase level during check up. She had a history of blood transfusion 12 years ago. Anti-HCV Ab by ELISA method and HCV RNA by RT-PCR were positive. HCV RNA by Amplicor HCV monitor test counted 800,000 IU/ml and the genotype was 3a by Specific Primer-Targeted Region Core method. Laboratory evaluation revealed: Hb 11.9 mg/dl, WBC 5000 /ml, platelet count 190,000/ ml, ALT 70 IU/ml, AST 65 IU/ml, Alk phosphatase 210, PT 13 second, total protein 7.2 g/dl, albumin 4 g/dl, gama globulin 1.6 g/dl, HBsAg negative and RF positive. She had a history of symmetrical polyarthritis of small joints of upper extremities and morning stiffness for 3 years ago and had been managed as rheumatoid arthritis [RA] since then. She was managed with corticosteroids and methotrexate. Are there any relations between RA disease and HCV infection?