Treatment of Chronic Hepatitis C Infection with Direct Acting Antivirals in Adolescents with Thalassemia Major.

OBJECTIVES: To assess the efficacy and safety of sofosbuvir based generic Direct Acting Antivirals (DAAs) in treatment of Hepatitis C virus (HCV) in adolescents with thalassemia major (TM). METHODS: In this prospective single-arm study, 18 TM adolescents with Chronic Hepatitis C received sofosbuvir based generic DAAs. Patients with genotype 1 and genotype 3 received ledipasvir and daclatasvir respectively. Two cirrhotic patients with genotype 3 also received ribavirin. RESULTS: The mean age of patients was 15.1 y, of which 12 had genotype 1, 5 had genotype 3 and 1 had an undetermined genotype. Six patients had cirrhosis and 1 was treatment experienced. Sixteen of 18 patients (89%; 95% confidence interval 74 to 100%) achieved sustained virological response at 3 mo post completion of treatment with DAAs. There was a significant reduction in alanine aminotransferase levels (p < 0.001), HCV RNA load (p < 0.001) and ferritin levels (p < 0.026) at 3 mo post completion of treatment. There were no major adverse events associated with the use of DAAs. CONCLUSIONS: Generic DAAs are effective and safe in TM adolescents with HCV.

Generic Direct Acting Antivirals in Treatment of Chronic Hepatitis C Infection in Patients of Thalassemia Major.

BACKGROUND: There is no published data of treating hepatitis C in thalassemia major patients with any sofosbuvir based direct acting antivirals (DAAs). This study was performed to determine the efficacy and safety of these regimes using generic drugs in the thalassemia major population. METHODS: In this observational study, 902 patients of thalassemia major from five transfusion centres in Mumbai were screened for HCV antibody. Of the 120 positive patients, HCV RNA was detected in 50%. The first 29 patients were enrolled for evaluating the efficacy and safety of generic sofosbuvir based DAAs. RESULTS: The 29 patients' had a mean age of 24 years with genotype 1 in 17, genotype 3 in 11patients, while 1 patient's genotype could not be classified. Six patients had compensated cirrhosis and 8 patients were treatment experienced. SVR 12 was achieved in 100% of patients. There was significant increase in PRC (packed red cell) requirements (P = 0.0003) during treatment. At 12 weeks post-treatment, PRC requirements returned to baseline with a significant fall in serum ferritin (P = 0.03). Headache, fatigue and diarrhoea were the most common side effects. The difference in side effects including anaemia between patients who received ribavirin (19/29) and those who did not receive ribavirin (10/29) was not significant. Presence of diabetes, splenectomy, high ferritin or liver or heart iron overload on MRI T2* did not affect the efficacy of treatment. CONCLUSION: Generic DAAs are safe in thalassemia major patients with hepatitis C with efficacy of 100%. Serum ferritin falls significantly after treatment despite an increase in transfusion requirements during treatment.

Perforating disorders of the skin.

BACKGROUND: Perforating disorders of the skin, is an often overlooked entity characterized by transepidermal elimination of material from the upper dermis and are classified histopathologically according to the type of epidermal disruption and the nature of the eliminated material. They include Kyrle's disease, perforating folliculitis, reactive perforating collagenosis, and elastosis perforans serpiginosa. AIM: The aim of this study was to delineate the clinical and histopathological features of perforating disorders of the skin. MATERIALS AND METHODS: In our study, we reviewed last 2 years skin biopsies received by us. Hematoxylin and eosin sections were re-examined and histochemical stainings (elastic van Gieson and Masson trichrome stains) were also used for histopathological evaluation. RESULTS: We reviewed five cases of perforating disorders of skin which included two cases of Kyrle's disease, two cases of reactive perforating collagenosis and a single case of perforating folliculitis. Two patients had family history of perforating dermatosis in their siblings and three had associated systemic disease. CONCLUSION: Perforating disorders of the skin should be considered when ulcer with keratotic plugs is found.