Chronic hepatitis C virus; dermatological manifestations of interferon plus ribavirin therapy in patients

To determine the frequency and pattern of dermatological manifestations in patients receiving interferon and ribavarin for hepatitis C. The study was conducted in the Dermatology out patients department [OPD] of Dow University Hospital Karachi from April -November 2013.Patients diagnosed with hepatitis C who received interferon a[3 MIU subcutaneously thrice weekly] plus ribavirin [1200 mg daily for 24 weeks].Detailed history and dermatological examination including mucous membrane, hair and nails was performed initially and then monthly for six months and findings were recorded. A total of 109 patients were included in the study. Frequency of various skin diseases in these patients werepruritis 44[40.36%], transient alopecia 14[12.84%],generalized morbiliform rash in 22 [20.18%],photosensitivity in 8[7.33%], secondary hyperpigmentation in 17[15.59%] patients. Lichen Planus was observed in 6 [5.50%] patients while brittle nails were seen in 5 [4.58%], glossitis in 4[3.66%],chelitis in 8[7.33%]and generalized exfoliating dermatitis in 9[8.25%] patients. Apthous ulceration was observed in 7 [6.42%] patients. HCV and its treatment with interferon plus ribavirin is associated with significant dermatological complications. Physicians should be aware of these side effects and patients should be counseled before starting treatment

Treatment profile of hepatitis C patients - a comparison of interferon alpha 2a and 2b treatment regimes

To compare the side effects, cost, end treatment response [ETR] and Sustained viral response [SVR] with combination therapy of either interferon alpha 2a or 2b in combination with Ribavarin. Randomized Control Clinical Trial [RCCT]. The study was conducted at Sarwar Zuberi Liver Centre [SZLC], Civil Hospital Karachi [CHK], from May 2004 to July 2009. Patients positive for qualitative HCV ribonucleic acid [RNA] by Polymerase chain reaction [PCA] and genotype 3 were included. Patients with decompensated cirrhosis, severe depressive illness, autoimmune hepatitis, hyperthyroidism, pregnancy, heart failure, uncontrolled diabetes, obstructive pulmonary disease, children less than three years and patients who had previously received treatment were excluded. Single blind randomization using computerized randomization list was done and patients divided into groups A and B, those requiring treatment were given injection Interferon 3 million units [MU] subcutaneously [SC] three times/week and Ribavarin 1000 mg per day [weight 75kg] orally with either interferon alpha 2a [group A; FDA approved products] or alpha 2b [group B; non FDA approved product]. Demographics, side effects, ETR and SVR were noted. ETR was defined as absence of virus at the end of treatment and SVR was taken as absence of HCV RNA at 6 months after completion of treatment. There were a total 310 patients with mean age of 34.07 +/- 9.38 years including 52.4% males, [n=162]. Majority of the patients were from North Pakistan. There were 155 patients each in group A and group B respectively. The cost of treatment for interferon alpha for a single patient for 6 months was Rs 60,000, while for Interferon alpha 2b was Rs 30,000. Side effects [fever initially, followed by fatigue, headache, musculoskeletal pain, depression, alopecia, insomnia, and anorexia] were more prominent in group B when compared with group A. In group A, ETR was 83.8% [130/155] while in group B was 83.2% [129/155]. While SVR available in group A was 61/70 [87.1%] and in group B was 60/72 [83.3%]. Response to combination therapy for HCV was 83%. ETR and SVR were similar for both interferon alpha 2a and 2b. Side effects though minor are more with alpha 2b [non FDA approved products]