Skip to main content
SpringerLink
Log in

Ushering a New Era in the Management of Hepatitis C in Children with Hematological Disorders

  • Short Communication
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Transfusion-transmitted hepatitis C is a major concern among thalassemia patients. Our aim is to estimate the prevalence of Hepatitis C infection among thalassemia patients and to assess the treatment response, adverse effects of Peg-interferon based regimen and the new direct-acting antiviral drugs. Patients with thalassemia receiving regular blood transfusions with positive anti HCV antibodies during a period from January 2012 to June 2017 were analyzed. Serial HCV viral load and genotype and liver function tests were performed. Peg interferon and Ribavirin were used in patients diagnosed before January 2016 and patients diagnosed after January 2016 were started on the combination of Ledipasvir/Sofosbuvir. Thirty-two patients aged between 2 and 28 years were analyzed. Genotype 1 was the predominant type. Twenty-one patients were initiated on Peg Interferon with Ribavirin, and 14 achieved sustained virological response. All of them had increased blood transfusion requirements with significant compliance issues. All eleven patients started on Ledipasvir and Sofosbuvir including 4 undergoing hematopoietic stem cell transplantation and 7 interferon failures showed sustained viral clearance with good compliance. Ledipasvir/Sofosbuvir combination can be safely used in thalassemia patients and in young children. The cost of therapy is less compared to peg interferon based regimen with good compliance and superior efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abbreviations

HCV:

Hepatitis C virus

AASLD:

American Association for the Study of the Liver Disease

EASL:

European Association for the Study of the Liver

DAAs:

Direct acting anti virals

SVR:

Sustained virological responcse

IFN:

Interferon

LDV:

Ledipasvir

SOF:

Sofosbuvir

References

  1. Thalassaemia International Federation (2015) HCV position paper. Viral hepatitis C in thalassaemia, pp 14–15

  2. Marwaha N, Sachdev S (2014) Current testing strategies for hepatitis C virus infection in blood donors and the way forward. World J Gastroenterol: WJG 20(11):2948

    Article  PubMed  Google Scholar 

  3. Di Marco V, Capra M, Angelucci E, Borgna-Pignatti C, Telfer P, Harmatz P, Kattamis A, Prossamariti L, Filosa A, Rund D, Gamberini MR (2010) Management of chronic viral hepatitis in patients with thalassemia: recommendations from an international panel. Blood 116(16):2875–2883

    Article  CAS  PubMed  Google Scholar 

  4. Craxi A, Pawlotsky J, Wedemeyer H, Bjoro K, Flisiak R, Forns X, Mondelli M, Peck Radosavljevic M, Rosenberg W, Sarrazin C, Jacobson I (2011) European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatitis C virus infection. J Hepatol 55(2):245–264

    Article  Google Scholar 

  5. European Association for Study of Liver (2015) EASL recommendations on treatment of hepatitis C. J Hepatol 63(1):199

    Article  Google Scholar 

  6. Food US (2014) Drug Administration approves Gilead’s Harvoni (ledipasvir/sofosbuvir), the first once-daily single tablet regimen for the treatment of genotype 1 chronic hepatitis C. [internet]. Foster City (CA): Gilead Sciences, Inc, p 4. Accessed 25 Nov 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm418365.htm

  7. Release FN (2017) FDA approves two hepatitis C drugs for pediatric patients. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm418365.htm

  8. Christofidou M, Lambropoulou-Karatza C, Dimitracopoulos G, Spiliopoulou I (2000) Distribution of hepatitis C virus genotypes in viremic patients with beta-thalassemia. Eur J Clin Microbiol Infect Dis 19(9):728–730

    Article  CAS  PubMed  Google Scholar 

  9. Butensky E, Pakbaz Z, Foote D, Walters MC, Vichinsky EP, Harmatz P (2005) Treatment of hepatitis C virus infection in thalassemia. Ann N Y Acad Sci 1054(1):290–299

    Article  CAS  PubMed  Google Scholar 

  10. Alavian SM, Tabatabaei SV (2010) Treatment of chronic hepatitis C in polytransfused thalassaemic patients: a meta-analysis. J Viral Hepatitis 17(4):236–244

    Article  Google Scholar 

  11. Afdhal N, Zeuzem S, Kwo P, Chojkier M, Gitlin N, Puoti M, Romero-Gomez M, Zarski JP, Agarwal K, Buggisch P, Foster GR (2014) Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med 370(20):1889–1898

    Article  CAS  PubMed  Google Scholar 

  12. Hill A, Khoo S, Fortunak J, Simmons B, Ford N (2014) Minimum costs for producing hepatitis C direct-acting antivirals for use in large-scale treatment access programs in developing countries. Clin Infect Dis 58(7):928–936

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Cancer Institute, 320, Padma complex, Chennai, 600035, India

    Meena Sivasankaran, Srinivas Sankaranarayanan, Dhaarani Jayaraman, Shivani Patel, Venkateswaran Vellaichamy Swaminathan, Ramya Uppuluri & Revathi Raj

  2. Voluntary Health Services Hospital Thalassemia Center, Chennai, India

    M Venkatadesikalu & V Mythili

Authors
  1. Meena Sivasankaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Venkatadesikalu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V Mythili
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Srinivas Sankaranarayanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dhaarani Jayaraman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shivani Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Venkateswaran Vellaichamy Swaminathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ramya Uppuluri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Revathi Raj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meena Sivasankaran.

Ethics declarations

Conflict of interest

All authors agree that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from the all the individual patients included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sivasankaran, M., Venkatadesikalu, M., Mythili, V. et al. Ushering a New Era in the Management of Hepatitis C in Children with Hematological Disorders. Indian J Hematol Blood Transfus 34, 739–741 (2018). https://doi.org/10.1007/s12288-018-0981-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-018-0981-6

Keywords

Search

Navigation