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Treatment of hepatitis C viral infection in patients with thalassemia major - the experience of an internal medicine department

Ionescui R.A., Daha Ioana Cristina, Onogea C., Nitescu Doina, Tanasescu C.
Abstract: Thalassemia major (also known as beta thalassemia major) is a disease that produces anemia that needs to be treated by regular blood transfusion. In turn, these has the risk of iron overload as well as that of infection with hepatitis C virus (HCV). Aim. This paper presents the experience of a tertiary internal medicine department in observing and treating major thalassemia patients having chronic hepatitis C viral infection. Matherial and methods. We have been following 21 patients with major thalassemia positive for anti HCV antibodies, of which 13 have detectable levels of viral RNA. Twelve of them are treated with standard of care treatment for thalassemic patients chronically infected with HCV, that is they receive PegInterferon-alfa-2b in standard doses for 48weeks. The iron load of the patients was assessed using ferritin plasma levels. The efficacy of treatment was appreciated by assessing RNA-HCV plasma levels at weeks 12, 24, 48 and 24 weeks after the completion of treatment. We also assessed alanin-amino-transferse levels, the need for transfusion and the occurrence of adverse events. Results. Ferritin levels were less than 1g/dl at 12 weeks into treatment in 10 of the 12 treated patients, while the plasma alanin-amino-transferase level normalized in 6 patients at week 12. We also had 8 complete early viral response after 12 weeks of treatment and 2 cases of hematologic side effects, one respiratory infection and 2 mild depression. Conclusion. Using Pegylates alfa-2b Interferon in our major thalassemia patients with chronic haptitis C infection can be efficacious in obtaining viral response, with a similar safety profile as that of non-thalassemic patients. In our small study, response to treatment seems to be parallel to the normalization of serum alanin-amino-transferase levels but not to the reduction of the iron overload.

Keywords: major thalassemia, hepatitis C virus infection, early viral response, safety


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