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Subject Area

Community Medicine

Article Type

Original Study

Abstract

Objectives To evaluate the effect of direct-acting antiviral agents (DAAs) on hepatitis C virus (HCV)-associated thrombocytopenia. Background The prevalence of thrombocytopenia in HCV infection ranged from 0.16 to 45.4%. The pathophysiology of HCV-associated thrombocytopenia is poorly understood and multifactorial. Cellular immunity has an important role. Antiplatelet antibodies are common. Production of thrombopoietin may be reduced. Infection of megakaryocytes with HCV may impair platelet production. Clearance of HCV with DAA is expected to restore innate functions of the hepatocytes and immune system reconstitution. Patients and methods This was a prospective study on 104 patients with HCV-associated thrombocytopenia receiving DAA (sofosbuvir and daclatasvir); the selected patients were followed up every 4 weeks during antiviral therapy, and at 24 weeks, clinically, and by complete blood count. Results The results show that the platelet counts initially decreased on starting the antiviral treatment, then increased gradually and steady during and after the treatment. Thirty-four patients obtained a normal platelet count of more than 150 000 × 103/mm3 at 24 weeks of starting the treatment, and 72 patients obtained a platelet count of more than 100 000 × 103/mm3 at 24 weeks of starting the treatment. There was a significant correlation with the Child–Pugh class, and FibroScan score, and no significant correlation with splenomegaly. Conclusion DAA therapy is an effective and safe treatment, and is recommended as a first-line treatment for HCV-associated thrombocytopenia. The main postulated mechanism of HCV-associated thrombocytopenia is the immune-mediated effects of HCV, and DAA therapy has the ability of immune system reconstitution.

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