Different Treatment Modalities for Improving HCV Response

Background and study aim: Hepatitis C virus is a major health problem throughout the world .Interferon (INF) was the only therapeutic opinion until the mid 1990s.Ribavirin(RBV) when added improve the SVR rate (8 to 42%) in patients with genotype 4 infection. Nitazoxanide induces a naturally occurring antiviral intracellular protein and a key mediator of host cell defense against viral infection, it is also believed that it inhibits viral glycoproteins at the post translational level. We aimed to study the impact of NTZ in addition to PEG-INFα 2a and RBV on virological response in patients with chronic hepatitis C. Patients and Methods: In this work, we studied 100 HCV patients who met the inclusion criteria of age, BMI, normal laboratory findings of liver and kidney functions, CBC, blood glucose level, thyroid functions and with absence of immunological disease. Quantitative PCR for HCV RNA and liver biopsy were done for each patient. Any patient showed more than F3 or A3 in this biopsy was excluded. All patients are followed clinically and by laboratory throughout the period of the study. All patients were divided into three groups: Group (A) received the SOC: PEG-IFN α2a 180µg and RBV (1000, 1200mg), group (B): received SOC and Nitazoxanide and group (C): received NTZ alone. Results: EVR in group (A) patients was 83.3% compared to 86.6% in group B patients . 24 week PCR negativity was 76.6% for group A and 80% for group B . As regard NTZ as a monotherapy ; four patients (10%) showed pEVR (>2log drop in HCV RNA) but they failed to achieve – ve HCV RNA at the end of treatment, nineteen patients showed <2log drop in HCV RNA at week 12. Out of these nineteen patients, 15 patients showed further decrease in HCV viral load at weeks 24. Abdominal pain 7%, nausea 5% vomiting 2.5%, urine discoloration 2.5% were the most side effects of NTZ. Conclusion: We can conclude that treatment modalities with PEG- INF, RBV and NTZ is associated with increase in virological response rates and monotherapy of CHC patients with NTZ decreases HCV RNA viral load in some patients, there was mild side effects attributable to NTZ.