Impact of cigarette smoking on response to interferon therapy in chronic hepatitis C Egyptian patients.
OBJECTIVE
Smoking may affect adversely the response rate to interferon-alpha. Our objective was to verify this issue among chronic hepatitis C patients.


METHODS
Over the year 1998, 138 chronic hepatitis C male Egyptian patients presenting to Cairo Liver Center, were divided on the basis of smoking habit into: group I which comprised 38 smoker patients (>30 cigarettes/d) and group II which included 84 non-smoker patients. Irregular and mild smokers (16 patients) were excluded. Non eligible patients for interferon-alpha therapy were excluded from the study and comprised 3/38 (normal ALT) in group I and 22/84 in group II (normal ALT, advanced cirrhosis and thrombocytopenia). Group I was randomly allocated into 2 sub-groups: group Ia comprised 18 patients who were subjected to therapeutic phlebotomy while sub-group Ib consisted of 17 patients who had no phlebotomy. In sub-group Ia, 3 patients with normal ALT after repeated phlebotomies were excluded from the study. Interferon-alpha 2b 3 MU/TIW was given for 6 mo to 15 patients in group Ia, 17 patients in group Ib and 62 patients in group II. Biochemical, virological end-of- treatment and sustained responses were evaluated.


RESULTS
At the end of interferon-alpha treatment, ALT was normalized in 3/15 patients (20%) in group Ia and 2/17 patients (11.8%) in group Ib compared to 17/62 patients (27.4%) in group II (P = 0.1). Whereas 2/15 patients (13.3%) in group Ia. and 2/17 patients (11.8%) in group Ib lost viraemia compared to 13/62 patients (26%) in group II (P = 0.3). Six months later, ALT was persistently normal in 2/15 patients (13.3%) in group 1a and 1/17 patients (5.9%) in group Ib compared to 9/62 patients (14.5%) in group II (P = 0.47). Viraemia was eliminated in 1/15 patients (6.7%) in group Ia and 1/17 patients (5.9%) in group Ib compared to 7/62 patients (11.3%) in group II, but the results did not mount to statistical significance (P = 0.4).


CONCLUSIONS
Smokers suffering from chronic hepatitis C tend to have a lower response rate to interferon-alpha compared to non-smokers. Therapeutic phlebotomy improves the response rate to interferon-alpha therapy among this group.
El-Zayadi
A
A
Department of Tropical medicine, Ain Shams University, Cairo, Egypt. clcz@tedata.net.eg
Selim
Osaima
O
Hamdy
H
H
El-Tawil
A
A
Badran
Hanaa-M
HM
Attia
M
M
Saeed
A
A
D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004347:Drug Interactions; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology*; D008297:Male; D018962:Phlebotomy; D011086:Polycythemia / Q000209:etiology / Q000628:therapy; D012907:Smoking / Q000009:adverse effects*
D000998:Antiviral Agents; D016898:Interferon-alpha; D000410:Alanine Transaminase