SUSTAIND VIROLOGICAL RESPONSE IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS GENO TYPE4 INFECTION TREATED BY ACOMBINATION THERAPY OF INTERFERON AND RIBAVIRIN

Abstract

Egypt has the highest HCV antibody prevalence in the world nearly14.7% of Egyptian population. The start of the epidemic is attributed to insufficiently sterilised intravenous injections during the mass anti-schistosomiasis treatment campaigns in rural areas during the 1970s. Spread of HCV has therefore been studied mainly in rural areas. An early survey documented HCV clustering among households of individuals with history of parenteral treatment for schistosomiasis. More recently, in cohort studies of rural areas of Egypt, having an anti-HCV-positive family member was the strongest predictor for incident HCV infection, after adjustment for iatrogenic and community exposures. Also, a mathematical model estimated that within HCV-infected couples, 6% would have acquired their infection from their partners. Treatment of chronic HCV genotype 4 infection in Egypt was depending on acombination of peg interferon and ribavirin but recently a directly acting anti viral drug sofosbuvir will be add to this regimen to improve treatment out comes From this point we designed our study to study the response of our Egyptian patients with chronic HCV geno type 4 infection to the combination therapy of Interferon/Ribavirin and to study the side effects of such regimen and to determine cases that had stopped treatment prmaturly and why. We randomly selected 100 patients who were already candidate for inf/rib therapy from the outpatient Hepatology Clinic in Al Mebara Hospital at Kafer Eldawar city at Al Behira Governorate who had completed their course of treatment and followed them retrospectively by history taking ,clinical examination and laboratory investigation where followed at (0-3-6-12-18) months of treatment by PCR for HCV-ALT-AST-ALP-TSH-S.billrubin (total-direct) and C.B.C at (0-2-4-12-20-28-36-44) weeks of treatment . Data were collected, tabulated and statistically analysed and revealed the following: - Our study revealed that 71% of the cases had achieved S.V.R, 11% relapses, 7% non responders, 4% of break thought. - Our study also revealed that 7% of the cases had stopped treatment due to side effects or complication of therapy. - Our study revealed also that the common side effects encountered during therapy are: flu like symptoms, fatigue, rash; headache, vomiting , nausea, arthralgia, dizziness. - Cases that had stopped treatment due to side effects or complications of therapy where 7% where due to neurological causes as hemiplegia and sensory affection as visual field disturbance. Cardiovascular causes as ischemic heart disease, haematological affection as severe anemia also sever incapacitating fatigue. From our study we concluded that inf/rib regemin in Egyptian HCV genotype 4 patients needs along duration of therapy (12 months) to achieve S.V.R that never reached 75% in all studies, with a long list of distressing side effects and serious neurological, C.V.S, endocrine and haematological effects, that always affect the patient compliance and response to treatment which eventually adversely affect the cure rates of HCV in Egypt. It’s recommend the use of the new direct acting antiviral drug sofosbuvir where studies recorded a S.V.R rates of nearly 96% in a 3 months duration of therapy for HCV genotype 4 patients and to study the response of Egyptian HCV +4 patients to its regimen and their compliance to this treatment.