Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 21, 2006; 12(35): 5692-5698
Published online Sep 21, 2006. doi: 10.3748/wjg.v12.i35.5692
Treatment of hepatitis C virus genotype 4 with peginterferon alfa-2a: Impact of bilharziasis and fibrosis stage
MF Derbala, SR Al Kaabi, NZ El Dweik, F Pasic, MT Butt, R Yakoob, A Al-Marri, AM Amer, N Morad, A Bener
MF Derbala, SR Al Kaabi, NZ El Dweik, F Pasic, MT Butt, R Yakoob, Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, Qatar
A Al-Marri, Department of Immunology, Hamad Medical Corporation, Doha, Qatar
AM Amer, Department of Haematology, Hamad Medical Corporation, Doha, Qatar
N Morad, Department of Histopathology, Hamad Medical Corporation, Doha, Qatar
A Bener, Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, Doha, Qatar
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor Moutaz Derbala, Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, Qatar.
Telephone: +974-4392439 Fax: +974-4392271
Received: April 17, 2006
Revised: May 15, 2006
Accepted: May 22, 2006
Published online: September 21, 2006

AIM: To evaluate pegylated interferon alpha2a (PegIFN-α2a) in Egyptian patients with HCV genotype 4, and the impact of pretreatment viral load, co-existent bilharziasis and histological liver changes on response rate.

METHODS: A total of 73 naïve patients (61 with history of bilharziasis) with compensated chronic HCV genotype 4 were enrolled into: group A (38 patients) who received 180 mg PegIFN-alpha2a subcutaneously once weekly for a year and group B (35 patients) received IFN alpha-2a 3 MU 3 times weekly. Ribavirin was added to each regimen at a dose of 1200 mg. Patients were followed for 72 wk and sustained response was assessed.

RESULTS: Significant improvement in both end of treatment response (ETR) (P < 0.002) and sustained response (SR) (P < 0.05) was noted with pegylated interferon, where ETR was achieved in 29 (76.3%) and 14 patients (40%) in both groups respectively, and 25 patients in group A (65.8%) and 9 (25.7%) in group B could retain negative viraemia by the end of follow up period. Sustained virological response (SVR) showed a significant negative correlation with age and positive correlation with pretreatment inflammation in patients receiving PegIFN. Viral clearance after 3 mo of therapy was associated with high incidence of ETR and SR (P < 0.001), but without significant difference between both forms of interferon. Significant improvement in response was achieved in patients with high grade fibrosis (grade 3 and 4) with PegIFN-α2a, where SR was seen in 5 out of 13 patients in group A, but none in group B. There was no significant difference in response between bilharzial and non-bilharzial patients in both groups. In terms of safety and tolerability, neutropenia was the predominant side effect; both drugs were comparable.

CONCLUSION: PegIFN-α2a combined with ribavirin results in improvement in sustained response in HCV genotype 4, irrespective of history of bilharzial infestation.

Keywords: Hepatitis C virus, Genotype 4, Pegasys, Bilharziasis