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Journal of Gastroenterology and Digestive Diseases | Volume 3
May 25-26, 2018 | New York, USA
World Liver Conference 2018
Introduction:
Advances in hepatitis C virus (HCV) drug
development in the last few years have taken a new turn
and the evolution of antiviral therapy for HCV has rapidly
progressed from interferon (IFN) up to the development
of direct-acting antivirals (DAAs) (Lutchman et al., 2015).
HCV infection can now be treated in almost all patients
with these tolerable and effective combinations of oral
DAAs. Now even those patients who due to advanced
liver disease or with co-morbidities were not eligible for
treatment by PEG-IFN-based regimens, or those who had
previous treatment failure, now have excellent choice of
treatment modalities (EASL, 2014). Perelló et al., reported
Herpesvirus (HV) reactivation in patients with HCV infection
treated with direct acting antiviral therapy (DAA) (Perelló et
al., 2016). Changes in the immune system after initiation of
DAAs could play a role in HV reactivation. However, the exact
mechanisms involved in HV reactivation in the early phases
of HCV clearance in patients treated with DAAs are not clear
(European Medicines Agency, 2016).
Patients andmethods:
This is a follow-up study including 100
chronic hepatitis C (CHC) patients attending the outpatient
clinics of the Tropical Medicine & Gastroenterology and the
Internal Medicine Departments-Qena University Hospital.
All eligible patients were included according to inclusion
criteria approved by the national committee for control
of viral hepatitis (NCCVH): Age 18-75 years, HCV RNA
positivity, any BMI (weight in kilograms/squared height
in meters), Treatment-naïve patients only were included
in this study. Exclusion criteria included HBV co-infection,
HIV, decompensated liver cirrhosis, inadequately controlled
diabetes mellitus (HbA1c >9%), hepatocellular carcinoma or
extra–hepatic malignancy. Diagnosis of Liver cirrhosis was on
clinical basis involving laboratory tests and ultrasonography
findings of liver cirrhosis and/or liver stiffness measurement
≥12.5 kPa (Castera et al., 2008). Patients were subjected to
history taking, clinical examination and routine laboratory
work up. All patients were treated with Sofosbuvir-based
treatment regimens according to the approved treatment
recommendations. The study was approved by ethical
committee of Qena Faculty of Medicine-South Valley
University. Written informed consent was obtained from all
patients before treatment.
Results:
Our study included 100 patients with mean age
45±12 years. Males were predominant presenting 69% of
our cases. 80% of cases were noncirrhotic at the start of
treatment and 20% of patients had evidence of liver cirrhosis.
Sustained virological response (SVR) was found in 94% of
treated patients while 6% of the treated patients relapsed.
Table 1 In the first two months after starting DAAs, we
encountered 4 noncirrhotic cases with vesicular eruptions
varying in distribution with 2 patients had vesicles over right
side of the chest and 2 patients had the vesicles extending to
the upper back. A diagnosis of Herpes Zoster (HZ) was made
after consultation of dermatology consultant who prescribed
antiviral and analgesics. All patients achieved SVR.
e:
alimena1@yahoo.comReactivation of herpesvirus in patients with hepatitis C treated with direct-acting antiviral agents
Ali A Ghweil
and
Mohamad M Helal
South Valley University, Egypt