HCV management under the diagnostic and therapeutic point of view in ID service

Abstract

Background: HCV is a major nosology due to the heterogeneity of infectious contingents, hepatic and extrahepatic pathological aggression, complex diagnostic algorithm and the difficulties of its efficient and stable treatment. Methods & Materials: 187 patients with HCV between 16-75 years old, followed up in ID service of University Hospital Centre “Mother Theresa”, during July 2005- July 2017. We classified cases based on age group, sex, and hepatic co-infections, and analyzed laboratory and therapeutic data for each patient. Results: The mean age of the patients was 54.4 (±7.7) years, range [16; 75]. 108 males and 79 females (male/female ratio1.3: 1). Hepatitis viral co-infections was present in 39 cases; HCV/HBV 11, HCV/HEV 1, HCV/HIV 23, HCV/HIV/HBV 4 cases. Based on laboratory data: In 96% of cases AST >35U/L, range [21;342]U/L and in 94.7% ALT > 45U/L, ALT range [19;1430]U/L. Bilirubin level resulted > 1.2 in 31% (0.5-4.9); Fibroscan was performed in 83% of cases; F4.21.4%; F3.41.6%; F2.30%; F1.7% of them. HCV RNA was achieved in79% of cases prior to initiation therapy, and ranged from 1.36 x 103 UI/ml to 6.6 x 107 UI/ml; Genotyping in 77 cases:genotype[1] 42 cases; genotype [1+ 4] 3; genotype [2]16; genotype [3]13; genotype [4] 3. According to therapy:182 pts were treated with antivirals: INFalfa 2a, 66 cases; PegINF/Ribavirin 107,Ledipasvir/Sofosbuvir 3, Sofosbuvir 3, Sofosbuvir/RIB 1, Elbasvir/Grazoprevir 1,Dasabuvir + Ombitasvir/Paritaprevir/Ritonavir 1. In 69 cases there were therapeutic failures from interferon (null response to therapy, 25; severe side effects by PegINF, 31; poor adherence, 13) and 2 exitus lethalis. Conclusion: It dominated the genotype 1 to 54.5% and the F3 stage of fibrosis to 41.6%. Hepatitis viral co-infections were encountered in 23.9% of cases, HVC + HIV in 65.7%. Therapeutic failure from Interferon in 39.8% of cases. Null therapeutic response, poor aderence and severe side effects of treatment with PegINF require the use of DAA.