Navegando por Palavras-chave "Sustained Virological Response"

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    Aspectos evolutivos de pacientes hemofílicos infectados pelo vírus da hepatite C
    (Universidade Federal de São Paulo (UNIFESP), 2020-12-10) Bastos, Dauana Arruda De Oliveira [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo
    Introduction: The improvement in the treatment of hemophilia from the 90's, as well as the advent of interferon-free therapy against the hepatitis C virus (HCV) for infected patients, enabled a better evolution of these special group of patients. However, the impact of hemophilia on the progression of liver fibrosis is still not completely understood. Objectives: To evaluate the progression of liver fibrosis in hemophiliac patients with HCV using non-invasive methods, in viremic (HCV-RNA positive) and non-viremic (HCV-RNA negative) patients, after ten years of follow-up. Casuistic and Method: Retrospective cohort study of hemophiliac patients with HCV followed since 2007 in a single tertiary Hematology center and reassessed 10 years later (2017/2018), in relation to biochemical tests, hepatic fibrosis (APRI, FIB-4 and transient hepatic elastography by Fibroscan ® - EHT), performance and response to antiviral therapy and outcome. The comparative statistical analysis was performed using the Wilcoxon test and the global survival curve was constructed using the Kaplan-Meier method. Results: The group of 66 patients evaluated in 2007 were men, with a median age of 31.5 years and 58 patients (87.9%) with hemophilia A. In the year 2017/2018, 42 (63.7%) patients were on medical follow-up and composed the revaluation sample. Antiviral therapy was performed in 33/42 patients and 30 (90.9%) reached SVR; thus, 30 and 12 patients (3 without SVR and 9 untreated) were non-viremic and viremic in the reassessment, respectively. There was a significant reduction in aminotransferases among the 30 non-viremic patients: AST (median 0.71 and 0.50, p <0.001), ALT (median 0.63 and 0.53, p = 0.026) and GGT (median 0.82 and 0.60, p = 0.004), between 2007 and 2017/2018, respectively. Also the APRI values showed a significant reduction (median of 0.36 and 0.20 in the two periods, p <0.001) only in the group without viremia. In relation to FIB-4, the values remained stable among patients with HCVRNA negative, and there was progression only among those with HCVRNA positive. Regarding the analysis of fibrosis by EHT, 8/33 treated patients (7 with SVR) performed it in the pre and post-treatment periods. There was a significant reduction in liver stiffness values in the post-treatment period (median from 7.9 kPa to 3.2 kPa, p = 0.018) among non-viremic patients. For the remaining 25/33 patients, the analysis of fibrosis by EHT was performed on a single occasion, and when done before treatment or in untreated patients, it showed few patients with advanced degrees of fibrosis. Regarding the outcome, the average cumulative overall survival of the 66 patients in the study, since the diagnosis of HCV infection, was 23.02 years (95% CI 24.49; 27.53). Conclusions: The results suggest a slower progression and a more benign evolution of hepatic fibrosis among hemophilics, with a different prognosis in relation to non-hemophiliac patients.Antiviral therapy against HCV showed an elevated response rate, similar to the general population.
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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.