Clinical Analysis Of Antiviral Treatment In 79 Cases With Hepatitis C

ObjectiveThe clinical data of 79 cases with hepatitis c(CHC)were retrospectively analyzed,and the antiviral efficacy and safety of different treatment regimens in different cases were discussed.MethodologyWe retrospectively analyzed clinical,biochemical and virological data of 79 patients with CHC from the second affiliated hospital of nanchang university during January 2014 to September 2017,who were treated with IFN á-2b+RBV or DAAs or INF+RBV+SOF,with a follow-up period ranging from pre-treatment until post-treatment 24 weeks.Including gender,age,baseline HCV RNA,transaminase and platelet levels before and after antiviral treatment;HCV RNA at week 4,12 and/or24 during treatment;HCV RNA at week 12,24 post-treatment.relapse and drug adverse reactions.The diagnosis of chronic HCV infection is based on the 2015 updated guidelines for the prevention and treatment of Hepatitis C.They were treated with IFN+RBV,DAAs,IFN+RBV+SOF.The exclusion criteria of the patients treated by IFN-basis regimens were as follows :(1)HIV coinfection;(2)severe systemic immune diseases;(3)uncontrolled hypertension and diabetes;(4)symptomatic heart disease;(5)uncontrollable neurological diseases;(6)having a history or family history of schizophrenia or severe depression;(6)decompensated cirrhosis;(7)accompanied by severe infection and cardiopulmonary disease;(8)Non-hepatic solid organ transplant recipients;(9)intolerance to adverse reactions of Interferon or Ribavirin;(10)severe anemia uncorrected,or hematopoietic disease;(11)severe renal impairment.The cases were divided into: IFN+RBV group in 14 cases,and the IFN-?-2b 5 million IU qod subcutaneous injection,combined with RBV400~500mg twice a day,and the duration of treatment ranged from 24 to 72 weeks.5cases of IFN+RBV+SOF group,the dose were the same as IFN+RBV group,combined with SOF 400 mg daily for 12 weeks.DAAs group of 60 cases(includingcirrhosis group(19 cases),the liver cirrhosis group 41 cases),and SOF 400 mg daily alone or combined DCV 60 mg daily or VEL 100 mg daily or LDV 90 mg daily or RBV 500 mg twice a day,including 12 weeks of treatment of patients with liver cirrhosis,liver cirrhosis treatment 24 weeks.The clinical characteristics of the patients were analyzed and compared.Statistical analysis was performed by SPSS 22.0.and P<0.05 was considered as statistical difference.Results1.Efficacy of each group:(1)IFN+RBV group: the RVR rate was 83.33%,the cEVR rate was 92.86%,the SVR12 rate was 78.57%,the SVR24 rate was 71.4%,the recurrence rate was 21.43%,the nonresponse rate was 7.14%.(2)DAAs groups: RVR,cEVR rate were 100%,SVR12,SVR24 rate were 90%,the recurrence rate was 10%.Among them,the recurrence rate of 4 cases with SOF alone were 100%.Excluding 4 cases who used SOF alone and all relapsed,the SVR12,SVR24 rate were 96.43%,the recurrence rate was 3.57%;(3)cirrhosis groups: the RVR,cEVR rate were 100%,the SVR12,SVR24 rate were 78.95%,the recurrence rate was 21.05%,Excluding 3 cases who used SOF alone and all relapsed,the SVR12,SVR24 rate were 93.75%,the recurrence rate was6.25%;(4)non-cirrhosis group: RVR rate and cEVR rate were 100%,SVR12 and SVR24 rate were 95.12%,the recurrence rate was 4.88%.Excluding 1 case who used SOF alone and relapsed,the SVR12 and SVR24 were 97.5%,the recurrence rate was2.5%.(5)IFN+RBV+SOF group: RVR,cEVR,SVR12,SVR24 rate were all 100%,the recurrence rate and nonresponse rate were all zero.2.Comparison of efficacy and side effects:(1)The SVR rate of DAAs regimens was higher than IFN+RBV regimens,and the difference was statistically significant(P<0.05).(2)The indicators of ALT,AST,PLT and FIB-4 were all improved after treatment,and the difference was statistically significant(P<0.05).(3)Patients with IFN-based regimens all showed different degrees of fever,fatigue,muscle pain and other flu-like symptoms.the incidence rate was 100%.1 case ended treatment because of being intolerant of side-effects while 4weeks treatment,and has been followed for 48 weeks,no relapse.The side-effects of the patients treated with IFN-free regimens were 1 case of nausea,1 case of skin itching and skin rash.The incidence rate was 3.33%.The incidence of side-effects was statistically significant(P<0.05).Conclusion(1)The antiviral regimens of IFN+RBV,DAAs,IFN+RBV+SOF reached a high SVR24 in 79 cases,which was better with DAAs;After antiviral treatment,the biochemical indexes were significantly improved.(2)DAAs could get better efficacy,shorter treatment,better security,and could be the first choice when drugs available and the economy affordable.