Medicine I, 'G.Brotzu' Hospital, Cagliari, Italy.
University of Cagliari, Italy.
Dig Liver Dis. 2019 Apr;51(4):561-567. doi: 10.1016/j.dld.2018.12.016. Epub 2019 Jan 3.
Direct antiviral agents (DAAs) have revolutionised the standard of care for the treatment of hepatitis even in patients with hemoglobinopathies. The aim of this study is to show how, thanks to DAAs, HCV infection has been substantially eradicated in one of the biggest Centres for the management of Thalassemia in Europe.
Thalassemia major patients regularly transfused and iron chelated in Cagliari (Italy) who were HCV-RNA positive were evaluated for the potential prescription of antiviral therapy.
A total of 99 patients, 26 of whom had been diagnosed with cirrhosis, were treated with at least one dose of DAAs, which proved to be safe and well tolerated. Two of the patients died during the treatment after becoming HCV-RNA negative while another voluntarily interrupted the therapy. The final SVR in the patients who completed the treatment was 100%, while measuring 97% (96/99) in the Intention-to-Treat analysis. After DAAs, no new cases of hepatocellular carcinoma have been reported.
The use of DAAs in patients suffering from beta-Thalassemia major with chronic hepatitis C or cirrhosis can be considered safe and effective. Close monitoring for hepatocellular carcinoma development is, in any case, recommended indefinitely post-SVR.
直接抗病毒药物（DAAs）彻底改变了慢性丙型肝炎的治疗标准，即使在合并血红蛋白病的患者中也是如此。本研究旨在展示在欧洲最大的地中海贫血治疗中心之一，DAAs 如何在很大程度上消除了 HCV 感染。
评估了在意大利卡利亚里定期输血和铁螯合治疗且 HCV-RNA 阳性的地中海贫血重型患者接受抗病毒治疗的可能性。
共有 99 例患者接受了至少一剂 DAA 治疗，其中 26 例患者已被诊断为肝硬化。结果表明 DAA 治疗安全且耐受性良好。2 例患者在 HCV-RNA 转阴后死亡，另 1 例患者自愿中断治疗。完成治疗的患者最终的 SVR 为 100%，意向性治疗分析中为 97%（96/99）。在 DAA 治疗后，未报告新的肝细胞癌病例。
在患有慢性丙型肝炎或肝硬化的β-地中海贫血重型患者中使用 DAA 可被认为是安全有效的。无论如何，建议在 SVR 后无限期地密切监测肝细胞癌的发生。
