Hepatitis C in patients with β-thalassemia major. A single-centre experience

Chronic hepatitis C (CHC) and iron overload are the main causes of liver disease in β-thalassemia major (βTM). There is limited data regarding the course of CHC in this population. All patients (n = 144) from the thalassemia centre of the University Hospital of Patras were evaluated (January 1981 to June 2012). Patients were classified into group A (n = 57), which consisted of patients with CHC, who either had received antiviral treatment (n = 49) or not (n = 8), and group B which included 87 patients without CHC. Nineteen patients died during follow-up (median: 257.5 months (1–355)). Survival rates were 84.2 % and 88.5 % for group A and B, respectively. The causes of death were heart failure (63.2 %), accident (10.5 %), sepsis (5.3 %), liver failure (5.3 %), hepatocellular carcinoma (HCC) (5.3 %), non-Hodgkin lymphoma (5.3 %) and multiorgan failure (5.3 %). There were no differences in total survival between the two groups (p = 0.524). In the multivariate analysis, survival was neither correlated with CHC (p = ns), nor with anti-HCV treatment (p = ns), whereas independent negative predictors were presence of heart failure (p < 0.001), presence of malignancy other than HCC (p = 0.001) and non-adherence to chelation treatment (p = 0.013). Predictive factors for the development of cirrhosis were: CHC (p < 0.001), age > 35 years (p = 0.007), siderosis grade 3/4 (p = 0.029) and splenectomy (p = 0.001); however, multivariately, only siderosis grade 3/4 was found to be significant (p = 0.049). In this study, survival of patients with βTM was mainly associated with heart failure, presence of malignancy other than HCC and non-adherence to chelation treatment, rather than with liver disease. Multicentre studies need to be designed to define more accurately the indications of antiviral treatment in this population.