title: Hepatitis C in patients with β-thalassemia major. A single-centre experience.
abstract: Chronic hepatitis C (CHC) and iron overload are the main causes of liver disease in β-thalassemia major (βTM). There is limited data regarding the course of CHC in this population. All patients (n=144) from the thalassemia centre of the University Hospital of Patras were evaluated (January 1981 to June 2012). Patients were classified into group A (n=57), which consisted of patients with CHC, who either had received antiviral treatment (n=49) or not (n=8), and group B which included 87 patients without CHC. Nineteen patients died during follow-up (median: 257.5 months (1-355)). Survival rates were 84.2 % and 88.5 % for group A and B, respectively. The causes of death were heart failure (63.2 %), accident (10.5 %), sepsis (5.3 %), liver failure (5.3 %), hepatocellular carcinoma (HCC) (5.3 %), non-Hodgkin lymphoma (5.3 %) and multiorgan failure (5.3 %). There were no differences in total survival between the two groups (p=0.524). In the multivariate analysis, survival was neither correlated with CHC (p=ns), nor with anti-HCV treatment (p=ns), whereas independent negative predictors were presence of heart failure (p<0.001), presence of malignancy other than HCC (p=0.001) and non-adherence to chelation treatment (p=0.013). Predictive factors for the development of cirrhosis were: CHC (p<0.001), age>35 years (p=0.007), siderosis grade 3/4 (p=0.029) and splenectomy (p=0.001); however, multivariately, only siderosis grade 3/4 was found to be significant (p=0.049). In this study, survival of patients with βTM was mainly associated with heart failure, presence of malignancy other than HCC and non-adherence to chelation treatment, rather than with liver disease. Multicentre studies need to be designed to define more accurately the indications of antiviral treatment in this population.
authors: Department of Gastroenterology, University Hospital of Patras, Stamatopoulou 4, Rio, 26504, Patras, Greece. chtriantos@hotmail.com
authors: Christos
authors: C
authors: Triantos
authors: Alexandra
authors: A
authors: Kourakli
authors: Maria
authors: M
authors: Kalafateli
authors: Dimitra
authors: D
authors: Giannakopoulou
authors: Nikolaos
authors: N
authors: Koukias
authors: Konstantinos
authors: K
authors: Thomopoulos
authors: Polixeni
authors: P
authors: Lampropoulou
authors: Christina
authors: C
authors: Bartzavali
authors: Helen
authors: H
authors: Fragopanagou
authors: George C
authors: GC
authors: Kagadis
authors: Mirto
authors: M
authors: Christofidou
authors: Athanasios
authors: A
authors: Tsamandas
authors: Vasiliki
authors: V
authors: Nikolopoulou
authors: Marina
authors: M
authors: Karakantza
authors: Chryssoula
authors: C
authors: Labropoulou-Karatza
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology; D002423:Cause of Death; D015913:Chelation Therapy; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006115:Greece / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007223:Infant; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000737:chemistry / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000706:statistics & numerical data; D065227:Transfusion Reaction; D055815:Young Adult; D017086:beta-Thalassemia / Q000453:epidemiology* / Q000628:therapy
chemical_list: D000998:Antiviral Agents; D007502:Iron Chelating Agents