[Experiences with the treatment of chronic hepatitis C and prognostic factors for its efficacy in clinical practice]. / Skúsenosti s liecbou chronickej hepatitídy C a prognostické faktory jej úspesnoti v klinickej praxi.

OBJECTIVE: The study aimed at evaluating antiviral therapy and the impact of selected factors on its efficacy in patients with chronic hepatitis C treated at the Department of Infectology and Travel Medicine in Kosice, Slovakia, between 2003 and 2007. MATERIAL AND METHODS: A retrospective analysis of a group of 213 patients treated for chronic hepatitis C and of prognostic factors for treatment efficacy in a subgroup of 159 patients who completed therapy with pegylated interferon alpha and ribavirin. RESULTS: From the entire group, 193 patients were treated with a combination of pegylated interferon and ribavirin, 5 received pegylated interferon monotherapy and in 15 cases, conventional interferon was used. A total of 179 patients (84 %) were treated for the first time, the remaining 34 patients were treated repeatedly. Genotype 1 was detected in 91.5 % of 189 studied patients. Liver biopsy was performed in 143 patients, with mild, moderate and severe histological changes or liver cirrhosis being detected in 46.9 %, 38.5 % and 14.7 % of them, respectively. In 12.2 % of cases, treatment was discontinued due to adverse effects. In the group of 159 patients who completed therapy, sustained viral response (SVR) was found in 35.8 %; another 12.6 % had viral response at the end of therapy (SVR has not been assessed as yet). Viral relapse or breakthrough were observed in 26.4 % and 25.2 % showed no response. Patients who achieved SVR were more frequently infected with genotypes 2 and 3, had lower degrees of liver fibrosis, lower mean age and more frequently achieved complete early viral response. By contrast, the group of non-responders was characterized by a higher proportion of patients with reduced therapy below 80 %. The other observed differences such as male/female ratio, weight, proportion of patients with normal ALT activity or proportion of previously untreated patients were not significant. CONCLUSION: The efficacy of treatment in our group adjusted for the adverse proportion of genotypes and proportion of patients with repeated therapy was comparable with the literature data. The favorable prognostic factors observed in the group included infection with genotypes 2 or 3, lower degree of liver fibrosis and lower age.

[Haematologic adverse effects of treatment of chronic viral hepatitis B and C]. / Hematologické neziaduce úcinky liecby chronickej vírusovej hepatitídy B a C.

OBJECTIVE: To determine the incidence and severity of adverse effects of treatment in patients with chronic hepatitis B and C (CHB and CHC). MATERIAL AND METHODS: A group of 104 patients with CHC and 74 CHB patients treated in 1994-2005 was evaluated. The patients were divided according to their treatment patterns and sex. Selected haematologic parameters (haemoglobin, neutrophil and platelet counts) were assessed. RESULTS: In CHC patients treated with interferon alpha (IFN), IFN alpha and ribavirin (IFN+RIB) or pegylated IFN alpha with ribavirin (PEG+RIB), and in CHB patients, anaemia was observed in 6 (37.5 %), 43 (56.6 %), 27 (54.0 %) and 11 (24.4 %) cases, respectively. Anaemia was significantly more frequent in women treated with IFN(RIB or PEG+RIB +p > 0.01 and p > 0.005, respectively), and in those with CHB (p > 0.005). The difference in the incidence of anaemia in those treated with RIB and without RIB was statistically significant (55.5 vs. 27.9 %, respectively, p > 0,001). In CHC patients treated with IFN, IFN+RIB or PEG+RIB, and in CHB patients, neutropenia was observed in 9 (56.3 %), 51 (67.1 %), 36 (72.0 %) and 20 (44.4 %) cases, respectively. In women treated with IFN+RIB or PEG+RIB, neutropenia was significantly more frequent (p > 0.05). In CHC patients treated with IFN, IFN+RIB or PEG+RIB, and in CHB patients, thrombocytopenia was detected in 9 (56.3%), 41 (53.9 %), 35 (70.0 %) and 23 (51.1 %) cases, respectively. No significant difference was noted in the incidence of neutropenia and thrombocytopenia between the individual treatment patterns used in CHC or CHB patients. In two cases, the treatment was discontinued due to its adverse effects. CONCLUSIONS: The data confirm a high incidence of haematologic adverse effects, mostly mild. From the point of view of haematologic complications, the treatment may be classified as safe.