Sa1317 Does Race Impact HCV Knowledge Among Oklahomans?

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Background and aims: Peginterferon (Peg-IFN) alpha in combination with ribavirin (RBV) represents the current optimal therapy for chronic hepatitis C (CHC). Interstitial pneumonitis is a rare but rapidly progressing and potentially fatal adverse event that has been described. The review includes an illustrative patient to clarify diagnosis and educate treating team on management strategies. Methodology: A systematic literature search reporting patients with interstitial pneumonitis who had radiological confirmation, and if possible histological confirmation of the condition. Patients who had undergone interferon-based therapy, either as a standalone therapy or in combination with ribavirin, were included. The indication for the use of Interferon-based therapy was for Hepatitis C only.Results: 33 cases of Interferonrelated interstitial pneumonitis were found, including the patient in the present review. The median age at presentation of 56.1 years (range 39-72 years) with no gender preponderance with 17 males (51.5%) and 16 females (48.5%). There appears to be a significant proportion of affected patients having been on Interferon-alpha-2b which was prescribed in 57.5% of patient (19 patients). On review of the published cases, the mortality rate is 12% with 4 deceased patients. All these patients were treated with Interferon-alpha-2b. The causes of death were multisystem organ failure, chronic hypoxia-induced cerebral oedema, acute cholestatic hepatitis and liver failure and as with our patient, hypoxic respiratory failure. HRCT is the radiological investigation of choice for suspected interstitial pneumonitis, with bronchoalveolar lavage (BAL) findings being not specific. HRCT often shows ground-glass opacities that may be patchy or diffuse, with upper lobe-predominant centrilobular illdefined nodules. Bronchioalveolar lavage findings include lymphocytosis >50%, a low CD4 to CD8 ratio, and occasionally, an increase in neutrophils. In all the reported cases, the culprit drug was ceased. Majority (nineteen patients) were commenced on steroid therapy. All four deaths occurred during or after treatment with intravenous steroids. In one of the patients with relapsed disease, Azathioprine was added. Conclusion: Interstitial pneumonitis is a rare, but life-threatening side effect that should be considered in the differential diagnosis of patients presenting with respiratory symptoms during or after Interferon-based therapy. There is lack of data to guide treatment and current practice is to cease the said drug and commence high dose steroids, either in oral or intravenous form. Pre-treatment respiratory function tests and CT scan with mid-treatment follow-up shoule be considered in all patients on treatment and the early withdrawal of treatment is advocated in patients with rapid clinical decline.