Experiência de um centro de referência de São Paulo no acompanhamento de pacientes com hepatite C crônica
Data
2018-03-26
Autores
Luzeiro, Camila 
Orientadores
Castelo Filho, Adauto
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Em 2015 aproximadamente 71 milhões de pessoas viviam com o vírus
da hepatite C (HCV) em todo o mundo e ocorreram 1,75 milhão de novas infecções
por HCV naquele ano. Daqueles com infecção crônica pelo HCV, somente cerca de
20% evoluirão para fibrose hepática avançada. O objetivo do tratamento da hepatite
C crônica é controlar a progressão da doença hepática, diminuir as complicações
advindas da progressão da fibrose e manifestações extra hepáticas. As opções para
tratamento de infecção crônica pelo HCV vêm se tornando mais eficazes nos últimos
anos. Objetivo: Descrever características epidemiológicas, virológicas de pacientes
portadores de Hepatite C crônica acompanhados no Ambulatório de Hepatites Virais
da Disciplina de Infectologia da Escola Paulista de Medicina – UNIFESP (NUPAIG) e
resposta aos tratamentos instituídos. Métodos: Estudo epidemiológico
observacional longitudinal do tipo retrospectivo estudo de coorte histórica de base
populacional. O estudo revisou prontuários dos pacientes atendidos no ambulatório,
que iniciaram seguimento entre 20 de julho de 2010 e 23 dezembro de 2016.
Resultados: Total de 1027 prontuários de pacientes antiHCV reagentes foram
revisados, 514 mulheres e 513 homens, com idade média de 50 anos. Houve
predomínio do genótipo 1b. Observouse perda de seguimento ambulatorial de
34,9% (358) dos pacientes antes de iniciar tratamento. Iniciaram tratamento com
interferon peguilado+ribavirina 254 pacientes, com inibidores de protease de
primeira geração (IP) 71 pacientes, com antivirais de ação direta de segunda
geração (DAA) 255 pacientes. A taxa de RVS com esquema PegIFN+RBV foi
47,6%, com IP foi 33,8% e com DAAs 91,8%, considerando como falha recidivas
virológicas, interrupções por efeitos adversos e abandono. Discussão e
conclusões: 50% dos pacientes eram do sexo feminino, idade média de 50 anos,
com hipertensão arterial sistêmica em 19,3%. A taxa de abandono primário (antes
de iniciar qualquer tratamento) foi de 34,9%, o genótipo mais prevalente foi 1b
(38,1%), doença hepática avançada (F3/F4) estava presente em 28,6% dos
pacientes. A taxa de RVS com esquema PegIFN+RBV (47,6%) foi superior a taxa
com IP (33,8%), em decorrência do alto percentual de interrupção por efeitos
adversos. A taxa de RVS com DAAs aumentou significativamente para 91,8%,
revelando alta eficácia e baixa toxicidade do esquema atual de tratamento.
Background: Worldwide, there were approximately 71 million people chronically infected with the hepatitis C virus (HCV) in 2015. Of those, 20% will eventually progress to advanced fibrosis. The goal of treating chronic hepatitis C is to prevent the evolution to cirrhosis, its complications and extra hepatic manifestations. Treatment options have greatly improved in the last years. Objective: to describe the epidemiologic and virologic characteristics of HCV infected patients receiving care at the specialized outpatient service for viral hepatitis of the Division of Infectious Diseases of Escola Paulista de Medicina – UNIFESP, and their virologic response to treatment. Methods: this was retrospective, longitudinal, observational study – populationbased historical cohort. Records of all patients receiving care at that outpatient service between June 20, 2010 and December 23, 2016 were reviewed. Results: A total of 1027 records of antiHCV reagent patients were abstracted: 514 women and 513 men, mean age 50 years. The predominant genotype was 1b (34.9%) and 28.6% had advanced fibrosis. Pegylated interferon+ribavirin (Peg IFN+RBV) was administered to 254 patients, first generation protease inhibitors (IP telaprevir/boceprevir) to 71 patients, and direct antiviral agents (DAA) to 255 patients. The SVR rate after PegIFN+RBV was 47.6%, after IP 33.8%, and 91.8% after DAAs. Virologic relapses, discontinuation due to adverse events, lost to followup were counted as failures in intentionto treat analysis. Discussion and conclusions: Of the total sample 50% were female, mean age 50 years, 19.3% had arterial hypertension. Even before initiating any treatment, 34.9% lost retention; 1b was the prevailing genotype (38.1%) and advanced fibrosis (F3/F4) was present in 28.6% of the patients. SVR after PegIFN+RBV therapy (47.6%) was higher than after IP (33.8%), due a rather high percentage of treatment interruption due adverse effects with IP. SVR after DAAs (91.8%) increased significantly, translating high efficacy and low toxicity of the treatment regimen currently used in Brazil.
Background: Worldwide, there were approximately 71 million people chronically infected with the hepatitis C virus (HCV) in 2015. Of those, 20% will eventually progress to advanced fibrosis. The goal of treating chronic hepatitis C is to prevent the evolution to cirrhosis, its complications and extra hepatic manifestations. Treatment options have greatly improved in the last years. Objective: to describe the epidemiologic and virologic characteristics of HCV infected patients receiving care at the specialized outpatient service for viral hepatitis of the Division of Infectious Diseases of Escola Paulista de Medicina – UNIFESP, and their virologic response to treatment. Methods: this was retrospective, longitudinal, observational study – populationbased historical cohort. Records of all patients receiving care at that outpatient service between June 20, 2010 and December 23, 2016 were reviewed. Results: A total of 1027 records of antiHCV reagent patients were abstracted: 514 women and 513 men, mean age 50 years. The predominant genotype was 1b (34.9%) and 28.6% had advanced fibrosis. Pegylated interferon+ribavirin (Peg IFN+RBV) was administered to 254 patients, first generation protease inhibitors (IP telaprevir/boceprevir) to 71 patients, and direct antiviral agents (DAA) to 255 patients. The SVR rate after PegIFN+RBV was 47.6%, after IP 33.8%, and 91.8% after DAAs. Virologic relapses, discontinuation due to adverse events, lost to followup were counted as failures in intentionto treat analysis. Discussion and conclusions: Of the total sample 50% were female, mean age 50 years, 19.3% had arterial hypertension. Even before initiating any treatment, 34.9% lost retention; 1b was the prevailing genotype (38.1%) and advanced fibrosis (F3/F4) was present in 28.6% of the patients. SVR after PegIFN+RBV therapy (47.6%) was higher than after IP (33.8%), due a rather high percentage of treatment interruption due adverse effects with IP. SVR after DAAs (91.8%) increased significantly, translating high efficacy and low toxicity of the treatment regimen currently used in Brazil.
Descrição
Citação
LUZEIRO, Camila. Experiência de um centro de referência de São Paulo no acompanhamento de pacientes com hepatite C crônica. 2018. 50 f. Tese (Doutorado em Infectologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2018.