FINAL RESULTS OF A PROSPECTIVE TREATMENT PROGRAM FOR CHRONIC VIRAL HEPATITIS B AND C: HEALTH SERVICES DEVELOPMENT PROGRAM (HSDP)

Abstract

Background and Aims: Chronic Hepatitis B (CHB) and C (CHC) lead to chronic liver disease and complications if left untreated. A Health Services Development Program (HSDP) was approved by the Ministry of Health to evaluate the effectiveness of treatment and the outcomes of CHB and CHC.Methods: Eighty-three CHB and twenty-one CHC patients were included. Inclusion criteria were HBVDNA>105 copies/ml, abnormal Liver Function Tests (LFTs), cirrhosis and positive HCVRNA. Daily Lamivudine with/without Adefovir rescue therapy and pegylated interferon with ribavirin were prescribed. Exclusion criteria were hepatocellular carcinoma, renal failure, CHB/CHC/HIV co-infection. Outcomes measured were: proportion of patients who i) normalize LFTs, ii) achieve sustained virological remission, iii) improve Child-Pugh (CP) score, iv) develop liver related complications and v) die.Results: CHB: Thirty-one patients (37%) had baseline cirrhosis. The mean therapy duration was 67.5 months. At the end of study, 100% had undetectable HBVDNA and 98% had LFTs normalization. The majority (87%) had stable C-P score, of whom 11.42% had improvement of score >2 points. Lamivudine resistance developed in 59.5% requiring add-on Adefovir therapy. Eleven patients (13%) developed end stage liver disease complications. CHC: There were 21 patients (genotype1=62%). Eight patients (38%) had baseline cirrhosis. LFTs improved in 18 patients (86%). The overall end-of-treatment response and SVR were 95% and 86% while SVR for genotype 1 and 2/3 were 92% and 75% respectively. No major liver related complications or mortality were noted.Conclusion: It was a successful program with excellent outcomes of disease complication free in 87% of CHB patients.