Efficacy and safety of combined pegylated interferon/ribavirin therapy in the management of rheumatological manifestations of chronic HCV patients

BackgroundThe hepatitis C virus (HCV) epidemic is particularly devastating in Egypt where its prevalence is about 12%. Chronic HCV infection can result in the accumulation of immune complexes and stimulate antibodies, which can result in extrahepatic manifestations (EHM).Aim of the workTo assess the efficacy and safety of combined pegylated interferon and ribavirin therapy in the management of rheumatological EHM in HCV patients.Patients and methodsTwenty-seven out of 50 consecutive HCV patients with rheumatologic EHM were eligible and included in this study. All patients included in this study were subjected to full history taking, clinical examination and laboratory investigations.ResultsThe mean age of the patients was 43.8 ± 7.6 years. The clinical response of the patients was: 2 patients (7.4%) were complete clinical responders, 5 (18.5%) were partial responders, 3 (11.1%) showed relapse and 17 (63%) were non-responders. There was a significant improvement in the number of patients with fatigue, polymerase chain reaction positivity and elevated liver enzymes (p < 0.0001, p < 0.0001, p = 0.03, p = 0.01 respectively). There was no significant correlation between virological and clinical responses. There was a significant correlation between virological and biochemical responses (p = 0.02). Minor side effects of the AVT developed in 13 (48.1%) patients: anemia (n = 5), mild thrombocytopenia (n = 8), flu-like symptoms (n = 7) and mild depression (n = 1).ConclusionPeg IFN and ribavirin did not improve HCV rheumatological extrahepatic manifestations. Antiviral treatment may also induce or worsen autoimmune disorders and is sometimes associated with major immune-mediated adverse events.