Post interferon therapy decreases male fertility through gonadotoxic effect

Prevalence of hepatitis C virus [HCV] has been seen in more than 15% of Pakistani population. For the treatment of this infection, only two medicines, interferon, and ribavirin were approved in 1998. The concerned physicians evaluate side effects of these two antiviral drugs only during the treatment period. The long-term extra hepatic side effects are being neglected. This retrospective study was conducted with reference to induced infertility in HCV treated 40 male patients from the period 2008-2015. Possible effects of interferon therapy on fertility hormones and seminal parameters were assessed. Level of fertility hormones like serum Follicle Stimulating Hormone [FSH], Luteinizing Hormone [LH], and testosterone was measured. For seminal parameters, guidelines from World Health Organization [WHO] were followed. Among forty cases of HCV patients who received interferon, only 14 [35%] have children and 26 [65%] could not conceive [p = 0.0372]. After HCV treatment, HCV positive patients showed a significant change in the level of FSH, LH [p<0.05]. Especially, it decreased testosterone level [p=0.0096]. Similarly, HCV treatment significantly decreased sperm count [p = 0.001] and motility [p = 0.0005]

Pre-treatment predictors of response for assessing outcomes to standard treatment in infection with HCV genotype 3

To determine the role of pre-treatment predictors of response in assessing outcomes to standard treatment in HCV genotype 3. Observational study. Department of Medicine, KRL General Hospital, Islamabad, from December 2004 to December 2006. All patients with positive anti-HCV and PCR genotype 3a were recruited and written and informed consent was taken. Patients were treated with standard Interferon plus Ribavirin therapy [IFN alpha-2a, 3MU t.i.w 24 weeks plus Ribavirin 1000-1200 mg/day] for 6 months. The effect of pre-treatment factors influencing outcome i.e. age, gender, weight, baseline ALT, necroinflammatory grade, fibrosis and steatosis on the final outcome were further analyzed by univariate logistic regression analysis. Response rates to standard Interferon plus Ribazole therapy were studied in 190 patients. The end-of-treatment complete response [EOTCR] was seen in 81% [n=155] of the patients, whereas 17% [n=33] were non-responders [NR]. Sustained viral response [SVR] was seen in 58% [n=112] patients and 24% [n=45] were relapsers. SVR was higher in patients without steatosis [OR = 2.52, 95% CI = 1.356-4.71, p = 0.04]. Higher SVR was seen in patients weighing less than 65 kg, as compared with weight > 65 kg [OR= 2.277, 95% CI = 1.246-4.161, p = 0.007]. The other variables were not found to be significantly associated with improved SVRs. Out of the studied predictors, body weight and presence of steatosis, were statistically related to treatment outcome. Pre-treatment host factors can predict response to treatment that can help in individualizing treatment and patient selection and optimize treatment outcomes

Response rates to standard interferon treatment in HCV genotype 3A

Chronic Hepatitis C infection infects almost 130 to 170 million or approximately 2.2-3% of world's population. HCV is one of the main causes of chronic liver disease leading to progressive liver injury, fibrosis, cirrhosis and liver cancer. It is also one of the leading indications for liver transplantation worldwide. The objective of the study was to determine the response of treatment with standard Interferon and Ribazole in treatment na‹ve Hepatitis C infected patients. This quasi-experimental study was carried out at the Department of Medicine, KRL General Hospital Islamabad, from January 2003 to January 2005. A total of 250 patients were enrolled in this descriptive study. All patients were anti HCV positive, PCR positive for HCV RNA and had 3a genotype. A non-probability purposive sampling technique was applied to collect data. After taking a written and informed consent; specially designed performa containing the patient profile, family transmission, and baseline laboratory values was filled. Patients were treated with a set protocol of Interferon plus Ribavarin therapy [IFN alpha 2a, 3 mIU thrice weekly for 24 weeks plus Ribavarin 1,000 to 1,200 mg/day] for six months. Chi-Square tests were used to analyse the data. Primary end point was a sustained virological response [SVR] that is response assessed after six months of completion of treatment. Response rates to standard Interferon plus Ribazole therapy were studied over two years period. Out of the total of 250 patients, 60 patients were excluded; as 30 patients did not meet inclusion criteria, 23 patients were lost to follow. Seven patients declined treatment. Out of the190 patients, 155 [81.6%] achieved End of Treatment Complete Response [EOTCR] whereas 35 [18.4%] were nonresponders [NR]. These 155 patients, who showed complete response were followed for six months after the treatment to assess sustained viral response, which was seen in 112 [72.25%] patients whereas 43 [27.7%] were relapsers. Response rates were co-related with gender, baseline ALT and necro-inflammatory stage assessed by liver biopsy, probable risk factors and family history. Management of Hepatitis C with genotype 3a, with standard Interferon and Ribazole for six months showed lower SVR compared to that reported in previous international and local data