Navegando por Palavras-chave "Direct-Acting Antiviral"

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    Avaliação da evolução da Fibrose Hepática em pacientes cirróticos com resposta virológica sustentada após tratamento de Hepatite C crônica
    (Universidade Federal de São Paulo (UNIFESP), 2019-09-11) Campos, Antonio Guelfer Saraiva [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background The advent of chronic hepatitis C therapy with direct acting antiviral agents (DAAs) without interferon made possible a cure rate in more than 90% of the infected patients and allowed the evaluation, through noninvasive measures, of changes in the stage disease and the development or resolution of hepatic complications. The objective of this study was to evaluate the evolution of hepatic fibrosis in cirrhotic patients with sustained virological response (SVR) after treatment of chronic hepatitis C with DAAs and to correlate the evolution pattern of hepatic fibrosis with clinical, laboratory and histological variables. Casuistic and Method: A total of 113 cirrhotic patients from the Hepatitis Division of the Federal University of Sao Paulo, treated between January 2016 and December 2017, were included. Non-invasive methods, APRI, FIB-4 and hepatic stiffness were measured using transient elastography (TE) before and after treatment. Results: The APRI and FIB-4 values showed a significant decrease in the comparison before and after treatment. APRI ranged from 2.52 (0.52 - 20.7) to 0.74 (0.24 - 3.82) post-treatment, (P <0.001). Likewise, FIB-4 showed improvement in the indexes, with FIB-4 from 5.71 (1.17 - 23.36) to 3.94 (0.83 - 16.46) post-treatment (P <0.001). In 52 /113 patients, TE was performed before and after treatment. The results showed a median pre-treatment of 21.65 kPa (8.3-48.8) with a significant reduction to 17.6 (5.3-88.0) after SVR (P<0.001). The laboratory parameters ALT, AST albumin and platelets also significatively improved after SVR. The stage of fibrosis assessed by hepatic elastography after a mean period of 14.6 ± 4.4 months, was maintained in 33/52 (63.5%) patients and there was improvement of the stage in 19/52 (36.5%). The absence of improvement in the stage of fibrosis was associated with the presence of portal hypertension (esophageal varices, splenomegaly and platelet count).Conclusions: In patients with hepatic cirrhosis due to hepatitis C, non-invasive fibrosis scores, APRI, FIB-4 and transient elastography obtained significant improvement after sustained virological response with direct-acting antiviral therapy. Improvement of these scores is probably a combination of resolution of hepatic inflammation as well as regression of liver fibrosis. In the presence of portal hypertension, the improvement in the stage of fibrosis in improbable.