FACTORS REFRACTORY TO CONVENTIONAL INTERFERON BASED THERAPY IN CHRONIC HEPATITIS C

OBJECTIVE: To determine the factors in patients suffering from chronic HCV, refractory to conventional interferon therapy. MATERIAL & METHODS: This descriptive case series study was conducted at Out Patient’s Department of Hepatitis Control Program at Medical Unit IV, LUMHS Hospital Jamshoro from June2013 to December 2013. Based on Inclusion and Exclusion criteria, a total of Eighty (80) patients with the established diagnosis of chronic Hepatitis ‘C’ were recruited by Non-probability consecutive sampling technique after obtaining a well informed and written consent. Socio-demographic data and history of alcohol addiction (>50gm/day), examination of weight and height to calculate BMI and Investigations including: HCV RNA by PCR and Liver Biopsy were recorded on a semi-structured proforma specifically designed for the study. RESULTS: A total of eighty (80) patients were included in the study who are refractory to conventional interferon therapy from which 49(61.20%) were male and 39(38.80%) were female. The mean age and SD were 40.70+6.37 years. On the basis of refractory category 57(71.2%) were non responders, 06(7.5%)were break through responders and 17(21.2%) were relapsers. On the BMI distribution mostly patients 55(68.80%) were with >30 and 25(31.20%) cases were between 25-30. Grade II steatosis was found in the mostly the cases 31(38.8%), Grade I steatosis was also commonest n in 30(37.5%) of the cases, while 15(18.8%) patients were found with Grade O steatosis and only 4(5%)cases were documented with Garde III steatosis. From total number only 25(31.25%) had history of alcohol addiction and from 25, 15(80.0%) patients were consuming >50 gm/day of alcohol and 05(20.0%) <50 gram/day. 56(70%) patients were noted with VL >8, 00000 IU/ml while 24(30%) patients were with viral load of <8, 00000 IU/ml. F2 was found commonest n in the patients 43(53.8%), while F1, F3, F0 and F4 were noted with frequency/ percentage of 21(26.2%), 08(10.0%), 06(7.5%), 02(2.5%) respectively. CONCLUSION: This study had concluded that there were a number of factors responsible for refractory treatment with conventional interferon based therapy in the cases of chronic HCV infection. Gender (male), age (>40 years), (BMI>30kg/m2), elevation of grade of steatosis, stage of fibrosis and high viral load are highly responsible factors. Therefore, it is recommended that all these common factors should be kept in mind during interferon therapy and future advance multidisciplinary studies will be conducted at various health care centers to compile the data and observe the other factors responsible for refractory treatment as far as HCV treatment is concerned.