Abstract
Background and study aim: The real life effect of anti-HCV direct acting agents (DAAs) on the hematologic profile and serum levels of vitamin B12 and folic acid was not yet fully studied. Patients and Methods: Between March 2018 and March 2019, a prospective study was designed at El-Rajhi University Hospital, Egypt, to randomly select HCV-related child A cirrhosis that were eligible for DAAs. All patients received oral sofosbuvir (SOF; 400 mg) plus daclatasvir (DCV; 60 mg) once daily plus weight based ribavirin (RBV): 1,000 mg/day if < 75 kg and 1,200 mg/day if ≥75 kg; regimen for 12 weeks. Hematologic profile, folic acid and B12 levels were assessed twice; before the start of therapy and at the end of week12 by electrochemiluminescence immune-assay. Results: A total of 25 patients were enrolled (age 50.11 ± 7.89 years, 15 males). The majority had no co morbidities. Hematologic profile in pre and post therapy showed significant decrease in hemoglobin levels after treatment (13.1 ± 0.93 Vs 11.15 ± 0.90, respectively; p=0.02). Folic acid level showed a significant decrease (14.56 ± 4.45 Vs 9.06 ± 2.11; respectively, p=0.01) and vitamin B12 levels showed a minor increase (345.09 ± 55.98 Vs 355.19 ± 33.45; respectively, p=0.08). Conclusion: Significant changes in the kinetics of B12 and folic acid were reported during the course of DAAs in management of chronic HCV with cirrhosis. Further large cohort and randomized controlled trial needed to study the effect of add-on these vitamins on the response rates.
Highlights
Millions of people are infected with hepatitis C virus (HCV) worldwide with the high risk of post hepatic cirrhosis and neoplasm [1]
These risks have been changed after the introduction of the direct acting antivirals (DAAs) to be improved and the main pool of risks were lessening into considerable percentages [2]
Liver cirrhosis is usually associated with hematologic upsets [4]
Summary
Millions of people are infected with hepatitis C virus (HCV) worldwide with the high risk of post hepatic cirrhosis and neoplasm [1]. These risks have been changed after the introduction of the direct acting antivirals (DAAs) to be improved and the main pool of risks were lessening into considerable percentages [2]. Liver cirrhosis is usually associated with hematologic upsets [4] Both folic acid (folic acid or vitamin B9) and cobalamin (vitamin B12) is important in red blood cell formation and for healthy cell growth, methylation of DNA, and function [5]. The real life effect of anti-HCV direct acting agents (DAAs) on the hematologic profile and serum levels of vitamin B12 and folic acid was not yet fully studied
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