doiSerbia

Autoimmune thyroid diseases in patients with chronic hepatitis C treated by pegylated interferon-alpha and ribavirin: A prospective study

Ružić Maja (Clinical Centre of Vojvodina, Clinic for Infectious Diseases, Medical Faculty, Novi Sad)
Fabri Milotka (Clinical Centre of Vojvodina, Clinic for Infectious Diseases, Medical Faculty, Novi Sad)
Stojanoska Medić Milica (Clinical Centre of Vojvodina, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Medical Faculty, Novi Sad)
Bajkin Ivana (Clinical Centre of Vojvodina, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Medical Faculty, Novi Sad)
Turkulov Vesna (Clinical Centre of Vojvodina, Clinic for Infectious Diseases, Medical Faculty, Novi Sad)
Abenavoli Ludovico (University “Magna Græcia”, Department of Health Sciences, Catanzaro, Italy)

Introduction/Objective. Despite sufficiently explained pathogenesis, today autoimmune thyroid diseases (AITD) are recognized as one of extra-hepatic manifestations of systemic hepatitis C virus infection. The aim of the present study was to determine clinical characteristics and to estimate the success of pegylated interferon-α2a plus ribavirin (pegIFN-α2a + RBV) therapy in patients with AITD as an extrahepatic manifestation of chronic hepatitis C infection (CHC). Methods. This prospective study included 91 CHC patients treated with pegIFN-α2a + RBV from 2010 to 2012 (39 women and 52 men, mean age 41.6 Ѓ} 11.9). The study group (group A) consisted of 31 patients with CHC and AITD. Control group (group B) consisted of 60 patients with CHC without AITD. We analyzed clinical, biochemical, virological, and histopathological markers of CHC, as well as response and side effects of pegIFN-α2a + RBV therapy. Results. There was a statistically significant difference in sex (p = 0.011), age (p = 0.001), AST level (p = 0.013), level of gamma globulins (p < 0.001), level of IgM (p = 0.007), IgG (p < 0.001), in the success of therapy of CHC with pegIFN-α2a + RBV between the groups. Odds ratio (OR) for unfavorable outcome in group A was 4.200 [95% confidence interval (CI): 1.545–11.417]. In final multivariate logistic regression analysis in group A, the only factor predicting sustained virological response was patients’ age (OR = 0.781; 95% CI: 0.603–0.959). The main side effects in group A were interferon induced thyroiditis (IIT) (41.9% vs. 3.3%; p < 0.001) and anemia, which was the only reason for dose reduction of ribavirin (29% vs. 6.7%; p = 0.027). Conclusion. Patients with AITD as an extra-hepatic manifestation of CHC achieve poorer virological response and their antiviral therapy is inevitably followed by a manifestation of adverse effects, predominantly solvable IITs and anemia.

Keywords: chronic hepatitis C, autoimmune thyroiddiseases, pegylated interferon alfa, ribavirin