Clinical significance blood platelet count in patients with chronic hepatitis C on the background of the various options combined antiviral therapy

The purpose of this research is the study of the dynamics of platelet count in blood of patients with chronic hepatitis C on the background of the combined antiviral therapy with standard or pegylated interferon-α in combination with ribavirin. Prior to treatment, as well as at different stages of combined antiviral therapy were studied absolute numbers of blood platelets in patients with chronic hepatitis C. We determined the relationship between platelet counts at different stages of antiviral therapy and baseline clinical and laboratory parameters (age, sex, body mass index, genotype, level of viremia, ALT, fibrosis), as well as alternative combination therapy. It is established that the significant decrease in platelet count in patients with chronic hepatitis C were observed as during treatment with pegylated or standard interferon-α in combination with ribavirin (38,5% and 16,0%, respectively, p < 0,05). Therapy with pegylated interferon-α treatment as compared with standard interferon-α was accompanied by a more pronounced decrease in platelets, peaking at 8 weeks of treatment (188,4±3,9×109/l). In addition, we observed a direct correlation between the level of blood platelets and rate of sustained virologic response. The study identified prognostic criteria, indicating the possible development of thrombocytopenia on the background of antiviral therapy: BMI < 20kg/m2, age over 45 years.

1. Лобзин, Ю.В. Вирусные гепатиты: клиника, диагностика, лечение / Ю.В. Лобзин, К.В. Жданов, В.М. Волжанин, Д.А. Гусев. – СПб. : Фолиант, 2003. – 192 с.

2. Fried, M.W. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection / M.W. Fried, M.L. Shiffman, K.R. Reddy et al. // N. Engl. J. Med. – 2002. – 347: 975–982.

3. Manns, M.P. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomized trial / M.P. Manns, J.G. McHutchison, S.C. Gordon et al. // Lancet. – 2001. – V. 358. – P. 958–965.

4. Никитин, И.Г. Лечение хронического гепатита С: вчера, сегодня, завтра / И.Г. Никитин // Росс. журн. гастроэнтерол., гепатол., коло проктол. – 2002. – № 6. – С. 11–16.

5. Яковлев, А.А. Гематологические нежелательные эффекты в процессе противовирусной терапии больных хроническим гепатитом С / А.А. Яковлев, С.Л. Фирсов, А.В. Опалихина и др. // Клинические перспективы гастроэнтерологии, гепатологии. – 2010. – № 4. – С. 19–24.

6. Mark, A. Interferons play a central role in the natural defense and therapeutic management of hepatitis C: a review / A. Mark, R.N. Outzen // Internet J. Gastroenterol. – 2007. – Vol. 5 (2).

7. Ong, J.P. Managing the hemotologic side effects of antiviral therapy for chronic hepatitis C: anrmia, neutropenia, and thrombocytopenia / J.P. Ong, Z.M. Younossi // Cleveland Clin. J. Med. – 2004. – Vol. 71,Suppl. 3. – P. S17–S21.

8. Sulkowski, M.S. Management of the hematologic complications of hepatitis С therapy / M.S. Sulkowski // Clin. Liver. Dis. – 2005. – Vol. 9. – P. 601–616.

9. Pellicano, R. Autoimmune manifestation during interferon therapy in patients with chronic hepatitis C: the hepatologist’s view / R. Pellicano, A. Smelide, S. Peyre et al. // Minerva gastroenterol. dietol. – 2005. – V. 51. – P. 55–61.

10. Davis, G.L. Early virologic response to treatment with peg interferon alfa-2b plus ribavirin in patients with chronic hepatitis C / G.L. Davis, J.В. Wong, J.G. McHutchison et al. // Hepatology. – 2003. – V.38. – P. 645–652.

11. Dieterich, D.T. Hematologic disorders asso ciated with hepatitis С virus infection and their management /D.T. Dieterich, J.L. Spivak // Clin. Infect. Dis. – 2003. – Vol. 37. – P. 533–541.

12. Fried, M.W. Peginterferon alfa-2a plus ribavirin for chronic hepatitis С virus infection / M.W. Fried, M.L. Shiftman, K.R. Reddy et al. // N. Engl. J. Med. – 2002. – Vol. 347. – P. 975–982.

13. Ong. J.P. Managing the hemotologic side effects of antiviral therapy for chronic hepatitis C: anrmia, neutropenia, and thrombocytopenia / J.P. Ong, Z.M. Younossi // Cleveland Clin. J. Med. – 2004. – Vol. 71, Suppl. 3. – P. S17–S21.

14. Poniachik, J. Management of adverse reactions to chronic hepatitis С treatment / J. Poniachik // Annals. Hepatol. – 2006. – Suppl. 1. – P. S67–68.

15. Spiegel, В.М. Impact of hepatitis С on health elated quality of life: a systematic review and quantitative assessment / В.М. Spiegel. Z.M. Younossi, R.D. Hays el al. // Hepatology, 2005. – Vol. 41. – P. 790–800.

16. Жданов, К.В. Лейкопения и нейтропения у больных хроническим гепатитом С на фоне различных вариантов комбинированной противовирусной терапии / К.В. Жданов, Д.А. Гусев, К.В. Козлов и др. // Журнал инфектологии. – 2011. – Т. 3, №2. – С. 74–80.