TREATMENT OF CHRONIC HEPATITIS-C WITH STANDARD INTERFERON AND RIBAVIRIN

Authors

  • Shakeel Ahmad Jadoon
  • Habib Ahmad Jadoon
  • Hassan Shahzad Nazar

Abstract

Background: The prevalence of hepatitis-C is on the rise in Pakistan. Treatment of chronic hepatitis-C with pegylated interferon is expensive as compared to standard interferon. The objective of the study was to find out the end treatment response rate with standard interferon and ribavirin. Methodology: This case series study was conducted in Ayub Teaching Hospital Abbottabad and Orush General Hospital over a period of two years.170 patients were included in the study. These patients were HCV PCR positive either by qualitative or quantitative assay, had no other comorbidity or decompensated disease. The treatment started with standard interferon and ribavirin for six months. After the six months at the end of treatment again HCV PCR assay was done to detect hepatitis-C virus in the blood. Those who were PCR negative were responders and positive are non-responder. Results: The cumulative response rate was 73.5%, both sexes responded equally. Patients below 30years had the highest response rate and similarly patients having normal liver had better response than those having any degree of fibrosis. Baseline haemoglobin and ALT level did not have significant effect on treatment. Conclusion: Standard interferon is equally effective and comparable with the pegylated interferon which is costly and out of reach of many patients. It is therefore recommended, that combination of standard interferon and ribavirin may be the first line of treatment for chronic hepatitis-C treatment in Pakistan and pegylated interferon may be reserved for non-responders or relapsed casesKeywords: Hepatitis-C, Interferon, Ribavirin, Cirrhosis, ALT

References

Hepatitis-C World Health Organization. Fact sheet No. 164. Geneva: WHO; 2012. Available Available at: w.who.int/vaccine research/viral cancers. Retrieved on 16-04-2009.

World Health Statistics. Geneva: World Health Organization. 2008.

Lavanchy D. The global burden of hepatitis-C . Liver Int 2009; 29(Suppl 1):74–81.

Marcellin P. Hepatitis B and C in 2009. Liver Int 2009; 29 (Suppl 1):1–8.

Raja NS, Janjua KA. Epedemiology of hepatitis-C virus infection in Pakistan. J Microbiol Immunol Infect 2008; 41:4–8.

Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis-C virus infection. Lancet Infect Dis 2005;5:558–67.

Viral hepatitis: global policy. London: World Hepatitis Alliance; 2011. Available at: http://www.hemophilia.ca/files/WHD_Issue_1_2011_-_EN.sflb.pdf

Pearlman BL, Traub N. Sustained virologic response to antiviral therapy for chronic hepatitis-C virus infection: a cure and so much more. Clin Infect Dis 2011;52:889–900

Lindsay KL, Trepo C, Heintges T, Shiffman ML, Gordon SC, Hoefs JC, et al. A randomized, double blind trial comparing pegylated interferon alfa-2b to interferon alfa-2b as initial treatment for chronic hepatitis-C . Hepatology 2001;34:395–403.

Zeuzem S, Feinman SV, Rasenack J, Heathcote EJ, Lai MY, Gane E, et al. Peginterferon alfa-2a in patients with chronic hepatitis-C . N Engl J Med 2000; 343:1666–72.

Shah HA, Jafri W, Malik I, Prescott L, Simmonds P. Hepatitis-C virus (HCV) genotypes and chronic liver disease in Pakistan. J Gastroenterol Hepatol 1997;12:758–61.

Idrees M, Riazuddin S. Frequency distribution of hepatitis-C virus genotypes in different geographical regions of Pakistan and their possible routes of transmission. BMC Infect Dis 2008;8:69.

Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis-C : a randomisedtrial. Lancet 2001;358(9286): 958–65.

Ghany MG, Nelson DR, Strader DB, Thomas DL, Seeff LB. An update on treatment of genotype 1 chronic hepatitis-C virus infection: 2011 Practice Guideline by the American Association for the Study of Liver Diseases. Hepatology 2011;54(4):1433–44.

Berg T, von Wagner M, Nasser S, Sarrazin C, Heintges T, Gerlach T, et al. Extended treatment duration for hepatitis-C virus type 1: comparing 48 versus 72 weeks of peginterferon-alfa-2a plus ribavirin. Gastroenterology 2006;130(4):1086–97.

Buti M, Lurie Y, Zakharova NG, Blokhina NP, Horban A, Teuber G, et al. Randomized trial of peginterferon alfa-2b and ribavirin for 48 or 72 weeks in patients with hepatitis-C virus genotype 1 and slow virologic response. Hepatology 2010;52(4):1201–7.

Jacobson IM, Brown RS Jr, McCone J, Black M, Albert C, Dragutsky MS, et al. Impact of weight-based ribavirin with peginterferon alfa-2b in African Americans with hepatitis-C virus genotype 1. Hepatology 2007;46(4):982–90.

Kau A, Vermehren J, Sarrazin C. Treatment predictors of a sustained virologic response in hepatitis B and C. J. Hepatol 2008;49(4):634–51.

Shiffman ML, Suter F, Bacon BR, Nelson D, Harley H, Solá R, et al. Peginterferon alfa-2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. N. Engl J Med 2007;357(2):124–34.

Huang CF, Yang JF, Dai CY, Huang JF, Hou NJ, Hsieh MY, et al. Efficacy and safety of pegylated interferon combined with ribavirin for the treatment of older patients with chronic hepatitis-C . J Infect Dis 2010;201(5):751–59.

Published

2014-06-01

Most read articles by the same author(s)