Abstract

Aim: This study evaluated the impact of Direct Acting Antivirals (DAA) on Thrombocytopenia and Fibrosis.

Background: Majority of transmission of Hepatitis C viral infections occur through transfusion of blood and blood products. Successful treatment of HCV infection with Pegylated IFN free DAA therapy is not having any impact on platelet improvement and fibrosis.

Primary objective: To assess DAA treatment response in progression of fibrosis in HCV patients and respective Genotypes 1,2,3,4,5 and 6.

Secondary objective: To assess treatment response of DAA through Sustainable Virological Response (SVR) in HCV patients.

Methods: A Prospective longitudinal study was conducted in Institute of hepato-biliary sciences, Madras Medical College, Chennai. This study included patients with Chronic Liver Disease (CLD) due to chronic HCV infection and treated successfully with DAA. Total of 302 patients were treated during this 2016-2018. Of these 135 patients diagnosed with cirrhosis were excluded from the study. A total of 167 patients with F1 to F3 (fibrosis) were included in the study. All the patients on DAA were followed up for a period of 2 years whether they achieved SVR or not. Patients were monitored with complete blood count, liver function tests, USG Abdomen and liver stiffness.

Results: 463 (57.3%) patients were male and 344 (42.6%) were female. Average age of male was 42.41 (± 16.69) and female was 44.22 (± 16.01). 261 (32.3%) patients had history of surgery and 232 (28.7%) patients had a history of blood transfusion. 111(13.75%) patients had hemodialysis for chronic kidney disease. 111 (13.75%) patients had comorbidity of Diabetic Mellitus and 112 (13.8%) had systemic hypertension. Among 807 serological positive patients 302 patients were enrolled for the treatment. Among them 161 patients with genotype 1, 5 patients with genotype 2, 117 patients with genotype 3, 18 patients with genotype 4, 1 patient with genotype 6 and all of them were followed up to End of the Treatment (ETR) and SVR. Genotype 1, 2, 4 and 6 achieved 100% SVR for DAA. Genotype 3 achieved only 97.95% of SVR for DAA Sofosbuvir (NS5B Polymerase inhibitor) and Daclatasvir (NS5A polymerase inhibitor).

Conclusion: Among the patients treated with DAA, SVR was not associated with considerable regression of fibrosis, also no significant improvement in platelet count in F1-F3 fibrosis even though patients achieved SVR. Genotype 3 patients with compensated cirrhosis did not achieve SVR with DAA therapy.

Keywords: Direct acting antivirals; Sustainable virological response; Hepatitis C virus; Thrombocytopenia