Recurrence of hepatitis C virus after treatment with pegylated interferon and direct acting antivirals in Punjab Pakistan

Although increased response rates concomitant in hepatitis C virus but relapse after treatment is threatened. Therefore, it is terrible requirement to evaluate the response of Pegylated interferon and direct acting antivirals in Punjab Pakistan. The study was conducted to find the rate of recurrence of HCV infection after treatment with Pegylated Interferon and Direct Acting Antivirals in Punjab Pakistan. This study was conducted at Department of Pathology, Nawaz Sharif Medical College Gujrat, while treatment effects monitored in different Government and Private Hospitals of Punjab, Pakistan. Total 973 patients who administered the recommended dose and divided in two groups (i) Interferon based therapy (ii) direct acting antivirals (DAAs).Other parameters like ALT and viral load studied. The rate of recurrence was higher in female infected with genotype 2b and in male with mixed genotype 3a/2b after six month of antiviral therapy. Genotype 3a showed significant response to therapy after three month. 32 among 374 (8.5%) were positive after 24 weeks of treatment with interferon, 29 (7.7%) patients have same genotype while 3 patients were re-infected with different HCV strains. With DAAs, only 27 (4.8%) patients were positive among 558 after 2 weeks and one patient re-infected with different genotype. Early and sustained virological response noted in DAAs. ALT and viral load decreased faster with DAAs that not achieved after 4 weeks with pegylated interferon. Sustained virological response appears in DAAs and recurrence rate is high in interferon therapy compared to DAAs. Therefore, reinfection has implications for correct treatment efficiency and to select strategies for retreatment cases.

Efficacy of Sofosbuvir and Daclatasvir in the Treatment of Chronic Hepatits C Viral Infection

Aim: To know the efficacy of combined therapy with sofosbuvir and daclatasvir, in patients suffering from chronic hepatitis C viral infection in Khyber Pakhtunkhwa. Study Design: Descriptive case series study. Place and duration of study: Department of Gastroenterology, Hayatabad Medical Complex, Peshawar, Pakistan, from 1stOctober 2017 to 28th February 2019. Methodology: Ninety eight patients were suffering from chronic hepatitis C infection enrolled. All patients were treated with sofosbuvir 400 mg and daclatasvir 60 mg daily for a period of three to six months. Ribavirin was added to the treatment of patients where indicated. All patients were followed 24 weeks after completion of treatmentto know the outcome in terms of sustained virological response (SVR). Results: The mean age of patients was 42.16±11.65 years, with 43 males and 55 females. Fifty one patients that received sofosbuvir and daclatasvir, achieved SVR rate of 88.23% (45/51) while 47 patients who were given sofosbuvir, daclatasvir and ribavirin , achieved SVR rate of 89.36 % (42/47). Six months after completing 12 to 24 weeks of treatment, a follow up PCR was done. The SVR rate, 24 weeks post treatment was 88.77% (87/98). The most common side effects observed were generalized body aches 24%, fatigue 21%, headache 10% and fever 6%. Conclusion: Once daily oral daclatasvir 60mg combined with sofosbuvir 400mg, with or without ribavirin proved effective, with SVR rate of 88.77%, in patients infected with chronic hepatitis C viral infection. Keywords: Direct acting antiviral, Chronic hepatitis C, Sustained virological response, Ribavirin, Efficacy, Sofosbuvir,

A case of acute exacerbation of chronic hepatitis C during the course of adrenal Cushing's syndrome

A 50-year-old woman with adrenal Cushing’s syndrome and chronic hepatitis C developed an acute exacerbation of chronic hepatitis C before adrenectomy. After administration of Glecaprevir/Pibrentasvir was started, her transaminase levels normalized promptly and a rapid virological response also was achieved. Then laparoscopic left adrenectomy was performed safely.

Efficacy of Sofosbuvir, Daclatasvir and Ribavirin combination therapy in treatment naive hepatitis C patients at tertiary care hospital of South Punjab

Introduction: Hepatitis C has gradually become endemic in Pakistan, with infectivity rates one of the highest in the world. The emergence of direct acting antivirals (DAAs) has become a ray of sunshine in eradicating this menace from this region. The combination of sofosbuvir, daclatasvir and ribavirin (SOF/DACLA/RIBA) has had phenomenal success all over the world in eradicating this virus. Our study aims to see the effectiveness of this regime in this part of the world. Methods: After approval from the institutional review board (IRB), retrospective analysis of data of treatment naive patients who have been treated with the above mentioned regimen was collected to assess the efficacy by calculating the sustained virological response (SVR) at 12 weeks after completion of therapy. Results: Data of 300 patients (172 females, 128 males) was collected. Mean age was 39.66 years. Majority (almost 90%) of patients were from District Multan Age range was from 18 years to 60 years. Eighty-three percent of the patients were non-cirrhotics, 15.7% had compensated cirrhosis, while only 1 % had decompensated cirrhosis. Out of the 300 patients, 291 patients had undetectable HCV RNA on polymerase chain reaction (PCR) at 12 weeks after completion of treatment, achieving SVR rates of 97%. There was no significant association of SVR rates with gender and age of patients. Conclusion: The combination of SOF/DACA/RIBA is highly efficacious for treatment of hepatitis C patients. Key Words: sofosbuvir, daclatasvir, efficacy, sustained virological response, hepatitis C

Real-World Experience of Chronic Hepatitis C-Related Compensated Liver Cirrhosis Treated with Glecaprevir/Pibrentasvir: A Multicenter Retrospective Study

Background: Glecaprevir/pibrentasvir is a protease inhibitor-containing pangenotypic direct-acting antiviral regimen that has been approved for the treatment of chronic hepatitis C. The present study aimed to evaluate the safety and efficacy of glecaprevir/pibrentasvir in patients with compensated cirrhosis in a real-world setting. Methods: We evaluated the real-world safety and efficacy of glecaprevir/pibrentasvir in patients with compensated cirrhosis from five hospitals in the Changhua Christian Care System, who underwent treatment between August 2018 and October 2020. The primary endpoint was a sustained virological response observed 12 weeks after completion of the treatment. Results: Ninety patients, including 70 patients who received the 12-week therapy and 20 patients who received the 8-week therapy, were enrolled. The mean age of the patients was 65 years, and 57.8% of the patients were males. Sixteen (17.8%) patients had end-stage renal disease, and 15 (16.7%) had co-existing hepatoma. The hepatitis C virus genotypes 1 (40%) and 2 (35.6%) were most common. The common side effects included anorexia (12.2%), pruritus (7.8%), abdominal discomfort (7.8%), and malaise (7.8%). Laboratory adverse grade ≥3 events included anemia (6.3%), thrombocytopenia (5.1%), and jaundice (2.2%). The overall sustained virological response rates were 94.4% and 97.7% in the intention-to-treat and per-protocol analyses, respectively. Conclusions: the glecaprevir/pibrentasvir treatment regimen was highly effective and well tolerated among patients with compensated cirrhosis in the real-world setting.