title: Dual therapy with peg-interferon and ribavirin in thalassemia major patients with chronic HCV infection: Is there still an indication?
abstract: BACKGROUND
  Iron overload and hepatitis C virus (HCV) infection together can lead to chronic liver damage in thalassemia major (TM) patients.
  
  
  OBJECTIVE
  We investigated viral, genetic, and disease factors influencing sustained virological response (SVR) after peg-interferon and ribavirin therapy in TM patients with HCV infection.
  
  
  METHODS
  We analyzed 230 TM patients with HCV infection (mean age 36.0±6.3 years; 59.1% genotype 1; 32.2% genotype 2; 3.4% genotype 3; and 5.3% genotype 4; 28.7% carried CC allele of rs12979860 in IL28B locus; 79.6% had chronic hepatitis and 20.4% cirrhosis; 63.5% naive and 36.5% previously treated with interferon alone) treated in 14 Italian centers.
  
  
  RESULTS
  By multivariate regression analysis SVR was independently associated with CC allele of IL28B SNP (OR 2.98; CI 95% 1.29-6.86; p=0.010) and rapid virologic response (OR 11.82; CI 95% 3.83-36.54; p<0.001) in 136 genotype 1 patients. Combining favorable variables the probability of SVR ranged from 31% to 93%. In genotype 2 patients, only RVR (OR 8.61; CI 95% 2.85-26.01; p<0.001) was associated with SVR higher than 80%. In 3 patients with cirrhosis a decompensation of liver or heart disease were observed. Over 50% of patients increased blood transfusions.
  
  
  CONCLUSIONS
  Dual therapy in TM patients with chronic HCV infection is efficacious in patients with the best virological, genetic and clinical predictors. Patients with cirrhosis have an increased risk of worsening liver or heart disease.
authors.affiliation: Sezione di Gastroenterologia & Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy. Electronic address: vito.dimarco@unipa.it.
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.affiliation: Divisione di Gastroenterologia & Epatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: D'Ambrosio
authors.affiliation: Sezione di Gastroenterologia & Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bronte
authors.affiliation: Unità di Gastroenterologia, Dipartimento di Oncologia, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Saracco
authors.affiliation: Unità di Epatologia, Azienda Ospedaliera "A. Cardarelli", Napoli, Italy.
authors.forename: Alfonso Galeota
authors.initials: AG
authors.lastname: Lanza
authors.affiliation: Ematologia - Centro della Microcitemia ed Anemie Congenite, Ospedale Galliera, Genova, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Forni
authors.affiliation: Dipartimento di Medicina Interna, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
authors.forename: Erika
authors.initials: E
authors.lastname: Poggiali
authors.affiliation: Sezione di Gastroenterologia & Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Calvaruso
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006331:Heart Diseases / Q000150:complications; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D007372:Interferons; D007378:Interleukins / Q000235:genetics; D007558:Italy; D008103:Liver Cirrhosis / Q000188:drug therapy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020641:Polymorphism, Single Nucleotide; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D017086:beta-Thalassemia / Q000150:complications* / Q000821:virology; D000095022:Interferon Lambda
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D007372:Interferons; D007378:Interleukins; D012254:Ribavirin; C000624353:interferon-lambda, human; D000095022:Interferon Lambda
keywords: Cirrhosis; Hepatitis C virus; IL28B polymorphisms; Iron liver overload; Peg-interferon; Ribavirin; Sustained virological response; Thalassemia major