الفهرس 
RESULTSOnly 14 pages are availabe for public view
 |  | from | 94 |  |  |
| | | from | 94 | | |
Abstract
Chronic HCV infection represents a world wide epidemic and is considered a major
public health problem. Combination therapy with pegylated interferon (PEG-IFN) and
ribavirin (RBV) is currently the standard for treating patients with chronic HCV and
selection of patients for this therapy depends on a long list of inclusion and exclusion
criteria.
Early virologic response (EVR) is defined as a F 2 log reduction or complete absence
of serum HCV-RNA at week 12 of therapy. Mid virologic response (MVR) is defined as
undetectable HCV-RNA at week 24 of treatment. End treatment response (ETR) is defined
as undetectable HCV-RNA at week 48 of treatment. Non- Response is defined as failure to
clear HCV-RNA from serum after 12 and 24 weeks of therapy. The molecular mechanism
underlying failure of IFN-J treatment are not understood but evidence indicate that both
viral and host predictors are involved.
The aim of this work is to study the impact of some predictors on response to
antiviral therapy in chronic HCV patients with special concern to pretreatment serum
ferritin level, which is relatively under-studied by researchers all over the world.
The current study included 200 chronic HCV patients presenting to liver center of El-
Qabbary hospital in Alexandria for receiving pegylated interferon plus ribavirin
combination therapy for 48 weeks. Before starting treatment, all candidates were subjected
to filling a predesigned questionnaire which included personal and demographic data
(name, age, sex, occupation, residence and socioeconomic status), habits and lifestyle,
medical history (chronic diseases and drug intake) and family history of liver disease. They
were subjected to routine investigations, liver function tests, serum creatinine, serum
ferritin, ANA, TSH, AFP, HBsAg, anti-HCV, viral load, anti-schistosomal Ab. BMI,
abdominal ultrasonography, liver biopsy, ECG and fundus examination were also done for
all candidates.
During treatment, every 4 weeks all patients were subjected to complete blood
picture and liver function tests. At 12 and 24 weeks of therapy, study participants were
subjected to PCR for HCV- RNA and serum ferritin. At 48 weeks of therapy; only 100
patients could be traced for 48 weeks to detect rate of end treatment response by PCR.
The main results of the present study included:
1. The response rate at 12 weeks (EVR) was 85%, at 24 weeks (MVR) was 80% and at
48 weeks (ETR) was 80%
2. Younger age patients responded to antiviral therapy significantly better than older
patients at all our check points.
3. Females responded better than males at 12 and 24 weeks, this was not statistically
significant but at end of treatment men significantly had better response rate than
women.
4. Patients with normal BMI had a non-significantly better EVR and MVR than obese
patients. However they had a significantly better response rate at 48 weeks of
treatment than obese patients.
5. Although smoking was significantly associated with non response at 12 weeks, it had
no significant effect at 24 and 48 weeks of treatment.
6. The pretreatment high viral load levels had a significant association with non
response at 3 and 6 months but not at 12 months of treatment.
7. The normal pretreatment ALT level was associated with better response at 3 months
but did not affect MVR rate, normal pretreatment AST levels was significantly
associated with EVR. At 6 months of therapy, no significant difference was found.
8. Hepatitic steatosis, had no effect on response of treatment at 3 and 6 months, while at
end of treatment presence of steatosis was significantly associated with non response
at end of treatment.
9. A lower Ishak staging score was significantly associated with better EVR, MVR and
ETR than higher Ishak staging score.
10. Pretreatment serum ferritin level, as one of the most important predictors, has a
strong association with response to anti-viral therapy. The normal serum ferritin was
associated with significantly better response than higher levels for EVR, MVR and
ETR.