Splenectomy and antiviral treatment for thrombocytopenic patients with chronic hepatitis C virus infection

• Published in: Journal of viral hepatitis Vol. 17; no. 7; pp. 488 - 492
• Main Authors: Ikezawa, K., Naito, M., Yumiba, T., Iwahashi, K., Onishi, Y., Kita, H., Nishio, A., Kanno, T., Matsuura, T., Ono, A., Chiba, M., Mizuno, T., Aketa, H., Maeda, K., Michida, T., Katayama, K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2010
• Subjects: Age; Aged; Antiviral Agents - therapeutic use; antiviral treatment; Chronic infection; Cirrhosis; Female; Genotypes; Hepatitis C virus; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Humans; Interferon; Interferon-alpha - therapeutic use; Male; Middle Aged; Platelets; Polyethylene Glycols - therapeutic use; Recombinant Proteins; Ribavirin; Ribavirin - therapeutic use; Spleen; Splenectomy; Splenomegaly; Splenomegaly - surgery; Thrombocytopenia; Thrombocytopenia - therapy; Treatment Outcome; Viral Load
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/j.1365-2893.2009.01211.x

Thrombocytopenic patients with chronic hepatitis C virus (HCV) infection are poor candidates for antiviral treatment with interferon (IFN), but no standard treatment for thrombocytopenia has yet been established. We evaluated the safety of splenectomy and its efficacy for the initiation and continuation of antiviral therapy. From March 2003 to April 2006, 10 patients (mean age 62.5 years) with HCV‐related cirrhosis, low platelet count (≦106 000/mm3) and splenomegaly (spleen size ≧10 cm) underwent splenectomy. Platelet counts significantly increased at 4–8 weeks after splenectomy [pre: 64 200 ± 6900/mm3vs post 209 000 ± 40 600/mm3 (P = 0.004)]. No severe operative complications were observed. All patients subsequently received antiviral therapy. Of the eight patients who were infected with HCV genotype 1 and had a high viral load (≧100 KIU/mL), four received combination therapy with pegylated IFNα‐2b plus ribavirin, and the other four received standard IFNα‐2b plus ribavirin. One patient infected with HCV genotype 2 and another with HCV genotype 1 and a low viral load (<100 KIU/mL) were treated with pegylated IFNα‐2a. Six patients achieved sustained virologic response (SVR). Among four patients who failed to achieve SVR, one was given retreatment with pegylated IFN plus ribavirin, and the other three received low‐dose long‐term IFN therapy. Although this study was small, the treatment results were similar to those for patients without thrombocytopenia and suggested that splenectomy would not reduce the antiviral efficacy of IFNα‐based treatment.