Author/Authors :
Tabatabaei, Vahid baqiyatallah university of medical sciences - Baqiyatallah Research Center for Gastroenterology and Liver Disease, ايران , Alavian, Moayed baqiyatallah university of medical sciences - Baqiyatallah Research Center for Gastroenterology and Liver Disease, ايران , Keshvari, Maryam Iranian Blood Transfusion Organization Research Centre (IBTO), ايران , Behnava, Bita baqiyatallah university of medical sciences - Baqiyatallah Research Center for Gastroenterology and Liver Disease, ايران , Miri, Mohammad baqiyatallah university of medical sciences - Baqiyatallah Research Center for Gastroenterology and Liver Disease, ايران , Karimi Elizee, Pegah Iranian Blood Transfusion Organization Research Centre (IBTO), ايران , Zamani, Farhad iran university of medical sciences - Liver Disease Research Center, ايران , Amini Kafiabad, Sedigheh Iranian Blood Transfusion Organization Research Centre (IBTO), ايران , Gharehbaghian, Ahmad Iranian Blood Transfusion Organization Research Centre (IBTO), ايران , Hajibeigy, Bashir Iranian Blood Transfusion Organization Research Centre (IBTO), ايران , Bagheri Lankarani, Kamran shiraz university of medical sciences, شيراز, ايران
Abstract :
Background: Treatment guidelines contraindicate ribavirin for treatment of hepatitis C virus (HCV) infection in thalassemia major patients. Nevertheless, the current evidence suggests that ribavirin might be tolerated by these patients.Objectives: Despite this evidence, low dose ribavirin combination therapy has not been compared with peginterferon monotherapy in these patients so far.Patients and Methods: Two hundred eighty thalassemia patients with detectable HCVRNAPCR (. 50 IU/mL) and liver histology consistent with chronic HCV infection were selfassigned to receive peginterferon alfa-2a (n = 81) monotherapy or its combination therapy with ribavirin, 600-800 mg QD, according to hemoglobin levels (n = 199). Treatment experienced patients were eligible for this study.Results: Sustained virological response (SVR) was significantly higher in patients who received ribavirin (51 % vs. 38 % P = 0.02). In multivariate regression, OR of ribavirin for prediction of SVR was 2.2 (95 % CI 1.24-3.91). The SVR was significantly higher in the ribavirin group in subgroups of patients with more than 24 years of age, elevated ALT, ferritin 2006 ng/mL, previous treatment failure, genotype 1, positive history of splenectomy, fibrosis score of 0-4 HAI and viral load 600,000 IU/mL. Treatment discontinuations due to the safety concerns were comparable between the treatment groups (6.5 and 8 %). Furthermore,transfusion intervals were almost halved in patients who received low dose ribavirin.Conclusions: According to the present study, adult thalassemia patients with HCV infectioncan be treated successfully with low dose ribavirin. Hence, we strongly advise combination therapy in thalassemia patients with aforementioned clinical characteristics.Moreover, ribavirin does not seem to be beneficial in thalassemia patients below 18 years of age.
