Treatment of chronic hepatitis C in sickle cell disease and thalassaemic patients with interferon and ribavirin.
OBJECTIVE
Hepatic complications are a major cause of death in patients with congenital anaemia and chronic hepatitis C. Ribavirin is usually contraindicated in patients with haemolytic anaemia. This pilot study evaluated the efficacy and safety of antiviral treatment in patients with sickle cell disease (SCD) or beta-thalassaemia major (TM).


METHODS
Eleven consecutive SCD and TM patients were included. Interferon monotherapy was administrated in the two first thalassaemic patients. Other patients received combination therapy with full dose of pegylated interferon 2b and increasing doses of ribavirin, starting with a low dose of ribavirin (400 mg/day).


RESULTS
Hepatitis C virus genotypes were 1 or 4 in nine cases. A sustained virological response achieved in five of 11 patients despite unfavourable factors to response (genotypes, nonresponders to an earlier treatment). Haemoglobin level at the end of treatment was higher than baseline levels in five of six SCD patients. No SCD patient needed a transfusion during and after treatment period, neither presented vasoocclusive crisis. The mean increase in transfusion requirements was 32.5% in the thalassaemic group.


CONCLUSIONS
A sustained virological response can be obtained in SCD and TM patients. No earlier study of excellent haematological tolerance among SCD patients under ribavirin has been reported to date. The results of this study suggest that full dose ribavirin could be used from the start of treatment in SCD patients.
Ancel
David
D
Hepatology Department, Tenon Hospital, Assistance Publique Hopitaux de Paris, Paris, France.
Amiot
Xavier
X
Chaslin-Ferbus
Dominique
D
Hagege
Isabelle
I
Garioud
Armand
A
Girot
Robert
R
Pol
Stanislas
S
Grange
Jean-Didier
JD
D000293:Adolescent; D000328:Adult; D000743:Anemia, Hemolytic / Q000139:chemically induced; D000755:Anemia, Sickle Cell / Q000150:complications*; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D010865:Pilot Projects; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult; D017086:beta-Thalassemia / Q000150:complications*
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons