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,

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.

L3 Skeletal Muscle Index Dynamics in Patients with HCV-Related Compensated Cirrhosis following Sustained Virological Response after Direct Acting Antiviral Treatment

Background and Objectives: Sarcopenia is commonly associated with liver cirrhosis and predicts clinical outcome. Our aim was to identify the changes in skeletal muscle index (SMI) on computed tomography (CT) examination, as a quantitative marker of sarcopenia, in patients with HCV-related cirrhosis after direct acting antivirals (DAAs) treatment and to assess predictive factors for the evolution of SMI. Materials and Methods: This is a single center retrospective study in patients with HCV-related compensated cirrhosis who obtained sustained virological response (SVR) after DAAs. CT examinations were performed in 52 patients before and within 5–24 months after treatment. The total muscle area (TMA) of abdominal muscle at the level of third lumbar vertebra (L3) was measured at baseline and after SVR. The L3-SMI was calculated from TMA divided by body height squared (cm2/m2). We assessed changes in L3-SMI after SVR according to baseline body mass index (BMI) and laboratory data. Predictive factors were assessed by linear regression model. Results: Patients with L3-SMI above the gender-specific cut-off value at baseline had higher values of serum creatinine (median 0.73) compared to patients with low L3-SMI (median 0.68, p = 0.031). After SVR, 14 patients showed increase of L3-SMI, and 38 patients had a decrease of L3-SMI. BMI in the decreased L3-SMI group was significantly lower (median 26.17) than those without decreased L3-SMI (median 28.84, p = 0.021). ALT values in the decreased L3-SMI group (median 66.5) were significantly lower than those without a decrease in L3-SMI (median 88, p = 0.045). Conclusions: Low creatinine serum level correlates with sarcopenia. SMI was partially influenced by the viral clearance. Lower BMI and ALT serum levels at baseline were predictive for no benefit in terms of muscle mass dynamics. Understanding all the mechanisms involved in sarcopenia and identifying the most vulnerable patients could ensure optimal adapted care strategies.

EFFECTIVENESS OF DIRECT-ACTING ANTIVIRAL DRUG THERAPY IN PATIENTS WITH CHRONIC VIRAL HEPATITIS C

All over the world hepatitis C is a global medical and social health problem, along with HIV infection, tuberculosis, hepatitis B, etc. According to the latest WHO estimates, the overall number of patients with chronic hepatitis C (CHC) in 2015 amounted to 71 million people (1 % of the world’s population). In Russia there are 5 million such patients. The largest number of people registered with CHC diagnosed in the Russian Federation is registered and lives in the Volga Federal District – 23.3 % (143,477 people). The incidence in the city of Ulyanovsk is very high (81.7 per 100 thousand of the population), and tends to grow steadily. The aim of this paper is to determine the effectiveness of 3D therapy in real clinical practice. Materials and Methods. Clinical charts of 151 patients with hepatitis C who underwent 8- and 12-week 3D and 3D+ ribavirin therapy (3 people) were analyzed. After therapy, the biochemical and virological responses were studied. The density of the liver tissue was determined on the FibriScanCompact 530 (Echosens, France). Results. There was a 100 % rate of sustained virological response to 8- and 12-week 3D therapy in complex groups of patients (extrahepatic manifestations, severe comorbid pathology, patients without previous responce to therapy). Triple therapy (Vikeira Pak) reduced the need for retreatment. Evaluation of interactions of direct antiviral drugs (3D scheme) in combination with ribavirin and without it was carried out with the most frequently prescribed drugs in the cohort of our patients. The 3D therapy regimen had a good safety profile: none of the patients cancelled treatment due to adverse events. Key words: chronic viral hepatitis C, 3D therapy, ombitasvir + paritaprevir + ritonavir, sustained virological response, genotype 1. Гепатит С является глобальной медико-социальной проблемой здравоохранения во всем мире наряду с такими заболеваниями, как ВИЧ-инфекция, туберкулез, гепатит В и ряд других инфекционных болезней. Согласно последним оценкам ВОЗ число больных хроническим гепатитом С (ХГС) в мире в 2015 г. составило 71 млн чел. (1 % населения Земли), из них 5 млн проживает в России. Наибольшее число лиц, состоящих на учете с диагнозом ХГС в РФ, зарегистрировано и проживает в Приволжском федеральном округе – 23,3 % (143 477 чел.). Заболеваемость в г. Ульяновске очень высока, составляет 81,7 на 100 тыс. населения и имеет тенденцию к неуклонному росту. Цель работы – определение эффективности 3D-терапии в реальной клинической практике. Материалы и методы. Проанализированы истории болезни 151 пациента с диагнозом «гепатит С». Все больные прошли курсы терапии 3D и 3D+рибавирин (3 чел.) в режиме 8 и 12 нед. Изучены биохимический, вирусологический ответы, после проведенного курса терапии определена плотность печеночной ткани на аппарате FibriScanCompact 530 (Echosens, Франция). Результаты. Доказана 100 % частота устойчивого вирусологического ответа на 8- и 12-недельные курсы 3D-терапии у сложных групп пациентов (с внепеченочными проявлениями, с тяжелой коморбидной патологией, у пациентов, ранее не отвечавших на терапию). Выбор трехкомпонентной терапии препаратом «Викейра Пак» обоснован возможностью снижения потребности в повторных курсах терапии. Оценка лекарственных взаимодействий препаратов прямого противовирусного действия схемы 3D в сочетании с рибавирином и без него производилась с наиболее часто назначаемыми препаратами в когорте наблюдаемых нами пациентов. Схема 3D-терапии имеет хороший профиль безопасности, ни один из пациентов не прекратил лечение в связи с нежелательными явлениями. Ключевые слова: хронический вирусный гепатит С, 3D-терапия, омбитасфир+паритапревир+ритонавир, устойчивый вирусологический ответ, генотип 1.

Assessment of Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV patients after sustained virological response to direct antiviral agents

Background Egypt has the highest prevalence rate of HCV in the world. About 14.7% of the Egyptian people have HCV antibodies and 9.8% have an active infection. The death rate due to liver disease about 40,000 each year (near10% of all deaths). It is the second after the cardiac diseases. Aim of Work to assess Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV Egyptian patients after sustained virological response to direct antiviral agents, and their correlation with liver stiffness measurements by Fibroscan. Patients and Methods This prospective cohort study was conducted at Viral Hepatitis Unit at Ain Shams University Hospital and Al-Agouza Police Hospital during the period from May 2018 to July 2019. The study included 50 Egyptian treatment-naïve chronic hepatitis C patients with cirrhosis on Sofosbuvir, Daclatasvir for 12 weeks. Patients were subjected to history and full physical examination, radiology assessment (Abdominal Ultrasound and color Doppler), Upper GI endoscopy and Fibroscan before treatment and 6 months after treatment. Followed up with CBC, AST, ALT, Total bilirubin, Albumin, creatinine and Coagulation profile before and after 12 weeks of treatment And HCV RNA by PCR and HCV CORE Antigen before and then after 12 weeks of treatment. Results Treatment with sofosbuvir plus Daclatasvir for 12weeks resulted in undetectable HCV RNA by PCR in 100% of the patients at the end of treatment. There was a significant improvement in portal hemodynamics 6 months after treatment as well as a significant correlation between Doppler indices and fibroscan. Conclusion: Doppler portal hypertensive parameters, as a marker of portal hypertension, were improved in parallel with the improvement in fibroscan values after viral clearance and its improvement in the current study mandate urgent treatment to avoid possible complications.