Hepatitis C in patients with β-thalassemia major. A single-centre experience

Abstract

Chronic hepatitis C (CHC) and iron overload are the main causes of liver disease in β-thalassemia major (βTM). There is limited data regarding the course of CHC in this population. All patients (n=144) from the thalassemia centre of the University Hospital of Patras were evaluated (January 1981 to June 2012). Patients were classified into group A (n=57), which consisted of patients with CHC, who either had received antiviral treatment (n=49) or not (n=8), and group B which included 87 patients without CHC. Nineteen patients died during follow-up (median: 257.5 months (1-355)). Survival rates were 84.2 % and 88.5 % for group A and B, respectively. The causes of death were heart failure (63.2 %), accident (10.5 %), sepsis (5.3 %), liver failure (5.3 %), hepatocellular carcinoma (HCC) (5.3 %), non-Hodgkin lymphoma (5.3 %) and multiorgan failure (5.3 %). There were no differences in total survival between the two groups (p=0.524). In the multivariate analysis, survival was neither correlated with CHC (p=ns), nor with anti-HCV treatment (p=ns), whereas independent negative predictors were presence of heart failure (p<0.001), presence of malignancy other than HCC (p=0.001) and non-adherence to chelation treatment (p=0.013). Predictive factors for the development of cirrhosis were: CHC (p<0.001), age>35 years (p=0.007), siderosis grade 3/4 (p=0.029) and splenectomy (p=0.001); however, multivariately, only siderosis grade 3/4 was found to be significant (p=0.049). In this study, survival of patients with βTM was mainly associated with heart failure, presence of malignancy other than HCC and non-adherence to chelation treatment, rather than with liver disease. Multicentre studies need to be designed to define more accurately the indications of antiviral treatment in this population.

Patients With Haemoglobinopathies and Chronic Hepatitis C: A Really Difficult to Treat Population in 2016?

“…This datum is in accordance with previous studies from Greece25,26 and other European countries 27. As far as HCV genotype is concerned, almost half of our patients were infected with genotype 1b, which is the most prevalent genotype among multitransfused patients [3,28].…”

“…As far as HCV genotype is concerned, almost half of our patients were infected with genotype 1b, which is the most prevalent genotype among multitransfused patients [3,28]. In addition, nearly 20% of the patients had cirrhosis before treatment initiation which is in accordance with previous studies in patients with CHC and thalassemia,3,26,29 while the rate of progression of liver disease to cirrhosis was 27% with a median disease duration of 23 years. The progression to cirrhosis seems to be higher than that expected in other patients with CHC without haemoglobinopathies 30,31.…”

Blood transfusion therapy for β‐thalassemia major and hemoglobin E β‐thalassemia: Adequacy, trends, and determinants in Sri Lanka

“…This raises serious concerns over the safety of blood products and reflects limitations of effective screening of blood donors. Our findings also confirm the results of previous studies that demonstrated lower pretransfusion hemoglobin levels among patients with splenomegaly, hepatomegaly, and hepatitis C infection 27,28. Similarly, we found that patients with hepatitis C infec-…”

Treatment of chronic hepatitis C with direct‐acting antivirals in patients with β‐thalassaemia major and advanced liver disease

“…The prevalence rates of hepatitis C virus (HCV) infection in adult patients with β‐thalassaemia major (β‐TM) have been reported to be high, although they vary widely among studies (Di Marco et al , ). Recent studies in Greece have shown prevalence rates ranging from about 40% to almost 75% (Kountouras et al , ; Triantos et al , ). In patients with β‐TM and chronic hepatitis C (CHC), the most prevalent HCV genotype is 1b, mirroring that of the general population in the same geographical areas (Di Marco et al , ).…”