Impact of Helicobacter pylori eradication on refractory thrombocytopenia in patients with chronic HCV awaiting antiviral therapy

Abstract

The possibility of delaying treatment of HCV due to severe thrombocytopenia is challenging. This study aimed to detect the prevalence of active helicobacter infection as a claimed cause of thrombocytopenia in a cohort of Egyptian patients with chronic active HCV awaiting combined anti-viral therapy. The study included 400 chronic HCV patients with thrombocytopenia. Laboratory investigations included liver function tests, real time quantitative PCR, reticulocytic count, ESR, ANA, bone marrow aspiration, measurement of anti-helicobacter antibodies, and helicobacter stool antigen. Positive cases for active H. pylori were given the standard triple therapy for 2 weeks. Helicobacter stool antigen was detected 4 weeks after termination of therapy and the change in platelet count was detected 1 month after eradication. A total of 248 out of 281 seropositive patients for H. pylori (88.3 %) showed positive stool antigen (p = 0.01). Eradication was achieved in 169 (68.1 %) patients with platelet mean count 114.9 ± 18.8 × 10(3)/μl with highly significant statistical difference from pretreatment value (49.7 ± 9.2 × 10(3)/μl, p = 0.000). Seventy-nine patients were resistant to conventional triple therapy and given a 7-day course of moxifloxacin-based therapy; 61 patients responded (77.1 %) with mean platelet improvement from 76.4 ± 17.4 × 10(3)/μl to 104.2 ± 15.2 × 10(3)/μl (p = 0.000). The non-responders showed no improvement in their platelet count (74.6 ± 20.5 vs. 73.6 ± 15.3 × 10(3)/ul, P = 0.5). Eradication of active H. pylori in HCV augments platelet count and enhances the early start of antiviral therapy.

Helicobacter pylori infection among patients with liver cirrhosis

“…In our observations, incidence of H. pylori infection among people infected with HCV or HBV was significantly higher (60.9–67.7%). These observations comply with the research by Hanafy et al 13 , who have demonstrated H. pylori infection in 70% (281/400) of patients chronically infected with HCV. A meta-analysis of 20 studies, performed by Wang et al 14 , clearly shows higher incidence of H. pylori infection among HCV-positive patients versus people not infected with the virus.…”

“…In the past, eradication of this bacteria led to increased platelet number, which allowed administration of antiviral treatment (with interferon). Moreover, the efficacy of antiviral therapies was better among people previously subjected to eradication of H. pylori 13 , 16 . At the moment, during the time of broad use of direct-acting antivirals, this probably does not seem so important; however, such studies have not been performed.…”

Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis

“…Our sample consisted of a total of 7,829 patients, including both genders aged between 2 and 75 years. Studies from Egypt (n=18) [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] , Saudi Arabia (n=8) [46][47][48][49][50][51][52][53] , Lebanon (n=6) [54][55][56][57][58][59] , UAE (n=5) [60][61][62][63][64] , Iraq (n=3) [65][66][67] , Qatar (n=3) [68][69][70] , Algeria (n=2) 71,72 , Palestine (n=1) 73 , Morocco (n=1) 74 , Syria (n=1) 75 , Yemen (n=1) 76 Tunisia (n=1) 77…”

The Importance of H. pylori Infection in Liver Diseases

“…However, many other authors present other observations. H. pylori infection may be present in even 70% of patients chronically infected with HCV [23]. Meta-analysis of 20 studies demonstrated higher incidence of H. pylori infection among HCV-positive patients, compared to persons without viral infection [17,24].…”

“…Many pieces of information argue that concomitant infection with H. pylori and HCV increases the incidence of HCC. Eradication of these bacteria in patients with cirrhotic liver leads to the increase of platelet count and improves efficacy of antiviral therapy [23,40]. In the current setting, when direct-acting antivirals are commonly used, this is probably not so important; however, such studies have not been performed.…”