Daclatasvir plus Sofosbuvir with or without ribavirin in patients with chronic Hepatitis C genotype 3a in Pakistani population - A real world experience.

BACKGROUND AND OBJECTIVES: Pakistan is among leading countries of world in prevalence of chronic hepatitis C Daclatasvir plus sofosbuvir is recommended for treatment of CHC. The purpose of study was to determine the sustained virological response in patients with chronic viral hepatitis C genotype 3a irrespective of previous treatment experience or presence of liver cirrhosis. METHODS: Open label observational study was conducted at ABSTH Gujrat from January 2017 to April 2018 using non-probability purposive sampling. Patients chronically infected with hepatitis C virus having genotype 3a irrespective of presence of cirrhosis or previous treatment experience were included. Treatment naive patients without cirrhosis were given 12 weeks regimen of daily daclatasvir 60mg along with daily sofosbuvir 400mg. Patients with either compensated cirrhosis or treatment experienced were given 24 weeks regimen of daily daclatasvir 60mg along with daily sofosbuvir 400mg with weight based ribavirin. Data analysis was done using SPSS 20.0. RESULTS: Total 125 patients were included in study out of which 42 (33.6%) were male and 83 (66.4%) were female. Early virological response and end treatment response was achieved by 124 (99.2%) patients. Twenty four patients were lost to further follow-up and SVR24 was available for 101(80.8%) patients out of which 48 were having cirrhosis and 53 were without cirrhosis. SVR24 was achieved by 96 patients (95%). Virological response was better in treatment naive patients and without cirrhosis compared to treatment experienced and those with cirrhosis. CONCLUSION: Daclatasvir plus sofosbuvir is an effective combination in patients with chronic hepatitis C genotype 3a infection.

Frequency of different types of gastric varices in patients with cirrhosis due to chronic hepatitis C.

OBJECTIVE: To determine the frequency of different types of gastric varices in patients with hepatitis C virus-related cirrhosis. METHODS: The observational cross-sectional study was conducted from August 2014 to August 2015 at Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan, using non-probability consecutive sampling. Patients having liver cirrhosis only due to chronic hepatitis C virus, portal vein diameter >12mm or spleen size >12cm in long axis and ascites with no previous history of variceal banding were included. Patients having cirrhosis due to other causes were excluded. Data was collected using a proforma that was filled by taking history, laboratory studies, abdominal ultrasound and upper gastrointestinal endoscopy. Gastric varices were classified using Sarin classification. SPSS 20 was used for statistical analysis. RESULTS: Out of 205 patients undergoing esophago-gastroduodenoscopy, 122(59.5%) were male and 83(40.5%) were female with an overall mean age of 49.5±7.49 years. Gastric varices were present in 30(14.6%) patients. Among them, type 1 was present in 23(76.71%), type 2 in 6(19.86%) and isolated gastric varices type 1 in 3(10.27%).Isolated gastric varices type 2 was not present in any patient. CONCLUSIONS: Gastric varices were present in minority of patients undergoing esophago-gastroduodenoscopy, and among them, gastroesophageal varices type 1 was the most common, while isolated gastric varices type 2 was not present in any patient.

Cholelithiasis in hepatic cirrhosis: evaluating the role of risk factors.

OBJECTIVE: To determine the role of risk factors, which promote cholelithasis in Hepatic Cirrhosis (HC). METHODS: A prospective study was conducted on indoor cases with advanced HC. Outpatients with compensated Chronic Liver Disease were used as control. The subjects with history of cholecystectomy and diabetes mellitus were excluded from the study. Conventional ultrasound was used for the detection of gallstones, ascites and portal hypertension. Sonography also furnished pertinent information about the portal vein diameter, size of the spleen, gallbladder wall thickness and echogenecity of the liver. RESULTS: The number of registered cases was 206: (age: 30-85 years): 121 (58.7%) males and 85 (41.3%) females. Hepatitis C (HCV) was the cause of HC in 187 (90.88%) cases. Of 50 (24.30%) patients with detectable gallstones, 27(54.00%) were males. We observed correlation of several risk factors with cholelithasis in our patients (n = 50): advanced age: mean 57.3 +/- 9.7 years (100%); prolonged duration of HC: 3.5 years (100%); Child-Pughs' class C: 34 (68%); increased thickness of gallbladder wall: 45 (90%); gross ascites: 39 (78%); splenic enlargement: 17.3 cm (100%); increased portal vein diameter: 13.4mm (100%). The results were statistically significant when compared with the control group (p = < 0.001). CONCLUSION: Gallstones tend to occur more frequently in patients with decompensated CLD due to interaction of several risk factors in these patients.