Hassan, E., Shatat, H., Kotkat, A., Mohamed, H., El-Raggal, A. (2000). Hepatitis C: to Treat or Not to Treat. Journal of High Institute of Public Health, 30(2), 413-430. doi: 10.21608/jhiph.2000.315237
Ezzat M. Hassan; Hanan Z. Shatat; Amira M. Kotkat; Hassan F. Mohamed; Ahmed H. El-Raggal. "Hepatitis C: to Treat or Not to Treat". Journal of High Institute of Public Health, 30, 2, 2000, 413-430. doi: 10.21608/jhiph.2000.315237
Hassan, E., Shatat, H., Kotkat, A., Mohamed, H., El-Raggal, A. (2000). 'Hepatitis C: to Treat or Not to Treat', Journal of High Institute of Public Health, 30(2), pp. 413-430. doi: 10.21608/jhiph.2000.315237
Hassan, E., Shatat, H., Kotkat, A., Mohamed, H., El-Raggal, A. Hepatitis C: to Treat or Not to Treat. Journal of High Institute of Public Health, 2000; 30(2): 413-430. doi: 10.21608/jhiph.2000.315237
Department of Tropical Health, High Institute of Public Health, Alexandria University, Egypt
Abstract
In Egypt, hepatitis C infection is a major public health problem. Its management is an important issue. So far, no known drug can eradicate HCV. Current therapy consists of antiviral and immunomodulatory agents aiming at altering viral replication and modifying the host immune response. The aim of this study was to evaluate the outcome of various commonly prescribed treatment regimens at end of treatment and after 6 &12 months. It is a prospective cohort study which started in 1997 and lasted for two years. The study included 225 patients proven to have chronic HCV infection by raised serum transaminases for more than 6 months, anti-HCV seropositivity using 3rd generation ELISA and HCV RNA positivity using PCR. Patients were grouped in 7 groups according to the therapeutic regimen they were offered. The study was designed to be conducted on 4 occasions: at day 0 [before treatment], after 6 months [end of treatment, 1st follow-up], 12 months [sustained response after 6 months i.e. 6-SR, 2nd follow-up] and after 18 months [12-SR, 3rd follow-up]. To assess the prognosis of the intervention therapy, we made use of reduction in serum ALT, the Child-Paugh score and disappearance of serum HCV RNA. Interferon IFN a-2a therapy was given at the conventional regimen 3MU trice weekly either for 6 months, 12 months or combined with ribavirin. It was valuable in inducing prominent clinicobiochemical ETR and SR. However, the virological ETR was discouraging as it was only [29%, 33.3% & 35%] in the three regimens respectively. Moreover, the virological response declined progressively by the 2nd and 3rd follow-up studies. Ribavirin, hepatotonics, oral enzymes as phlogenzymes and herbal treatment produced fair biochemical responses but negligible virological responses. Increasing age, pretreatment HCV RNA levels and treatment regimens were the only significant factors that influenced the biochemical and virological response. To conclude, this study failed to elect a specified mono- or combined therapeutic regimen for HCV infection. IFN± ribavirin is not exclusively ideal or superior to other therapies in treating cases with HCV infection. It seems that rest and hepatotonics are quiet sufficient to improve clinical picture and produce a satisfactory biochemical ETR and SR at early HCV infection. In the same time no ideal drug for eradication of HCV RNA has yet been elected.
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