Caracterização da Resposta Virológica Sustentada na Terapêutica da Hepatite C Crónica pela Avaliação à 4ª Semana

 

N. Marques ¹, J. E. Serra ¹, H. Alves ¹, F. Coelho ¹, J. G. Saraiva Da Cunha ¹, A. Meliço-Silvestre ¹

 

 

Resumo

 Introdução: Estudos recentes corroboram que a resposta virológica obtida à 4ª semana do tratamento da hepatite C crónica, denominada resposta virológica rápida representa o melhor valor preditivo positivo da resposta virológica sustentada (RVS).

Objectivos: Caracterizar uma amostra de doentes, que à 4ª semana de tratamento apresentou carga vírica indetectável.

Métodos: Análise retrospectiva dos processos clínicos dos doentes que terminaram tratamento num período de 2 anos (2004-2005).

Resultados: Foram incluídos 42 doentes, 10 dos quais co-infectados pelo VIH. A maioria possuía genótipo 1 (52,4%), baixa carga vírica VHC basal, ou seja inferior a 800 000 UI/ml (92,9%) e ALT elevada. A RVS foi de 85,7%.

Conclusões: A terapêutica deve ser individualizada e a relação custo-benefício deve ser ponderada com avaliação de eventuais efeitos tóxicos decorrentes da manutenção da terapêutica, especialmente nos indivíduos que, presumivelmente, não irão atingir uma RVS.

 

 

Summary

Introduction: Recent studies suggest that negative HCV-RNA at week 4 of HCV treatment, known as rapid virological response has a high positive predictive value of sustained virological response (SVR).

Aim: To describe a group of patients who achieved undetectable levels of HCV-RNA after 4 weeks of HCV treatment.

Methods: Retrospective study of patient’s clinical records of patients who have completed HCV treatment during a 2 years period (2004-2005).

Results: 42 patients were included, 10 of them co-infected by HIV. The majority of patients had HCV genotype 1 (52,4%), low HCV viral load [≤800 000 IU/ml] (92,9%) and elevated ALT. SVR was 85,7%.

Conclusions: Nowadays, an individualization of chronic hepatitis C treatment is required in order to allow those unlikely to achieve a SVR to be spared the expense and potential toxicities of continued therapy.

 

 

Texto Completo disponível apenas em PDF

Full text only available in PDF format

 

 

 

Bibliografia

 

1. Hepatitis C: Global prevalence. Wkly Epidemiol Rec 1997;72:341-4.

2. Marinho RT, Moura MC, Gíria JA, Ferrinho P. Epidemiological aspects of Hepatitis C in Portugal. J Gastroenterol Hepatol 2001;16:1076-77.        [ Links ]

3. Strader DB, Seeff LB. The natural history of chronic hepatitis C infection. Euro J Gastroenterol Hepatol 1996;8:324-8.

4. Fattovich G, Giustina G, Degos F, Diodati G, Tremolada F, Nevens F, et al. Effectiveness of interferon alpha on incidence of hepatocelular carcinoma and decompensation in cirrhosis type C. European Concerted Action on Viral Hepatitis (EUROHEP). J Hepatol 1997;27:201-5.

5. Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, Management, and Treatment of Hepatitis C. Hepatology 2004;39(4):1147-71.

6. Feld JJ, Hoofnagle JH. Mechanism of action of interferon and ribavirina in treatment of hepatitis C. Nature 2005;436:967-72.

7. Zeuzem S, Buti M, Ferenci P, Sperl J, Horsmans Y, Cianciara J, et al. Efficacy of 24 weeks treatment with peginterferon alpha-2b plus ribavirin in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia. J Hepatol 2006;44:97-103.

8. Ferenci P, Fried MW, Schiffman ML, Smith CI, Marinos G, Gonçales FL, et al. Predicting sustained virological responses in chronic hepatitis C patients treated with peginterferon alfa-2a (40KD)/ribavirin. J Hepatol 2005;43:425-33.

9. Thomas DL, Ray SC, Lemon SM. Hepatitis C. In Mandell GL, Douglas RG, Bennett JE, Dolin E,eds. Principles and Practice of Infectious Diseases, 6th. Ed. Philadelphia: Churchill Livingstone;2005:1950-81.

10. Marques N, Serra JE, Saraiva da Cunha JG, Meliço-Silvestre A. HCV Epidemiological, Clinical and Histological Aspects in Monoinfected and Co-infected (HIV) Patients [abstract 59.011]. Presented at: 12th International Congress on Infectious Diseases; June 15-18, 2006; Lisbon.

11. Mangia A, Santoro R, Minerva N, Ricci GL, Carretta V, Persico M, et al. Peginterferon-alpha-2b and ribavirin for 12 vs. 24 weeks in HCV genotype 2 or 3. N Engl J Med 2005;352:2609-17.

12. Von Wagner M, Huber M, Berg T, Hinrichsen H, Rasenack J, Heintges T, et al. Peginterferon-alpha-2a (40KD) and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C. Gastroenterology 2005;129:522-7.

13. Dalgard O, Bjoro K, Hellum KB, Myrvang B, Ritland S, Skaug K, et al. Treatment with pegylated interferon and ribavirin in HCV infection with genotype 2 or 3 for 14 weeks: a pilot study. Hepatology 2004;40:1260-5.

14. Wong JB, Zeuzem S, Manns MP, Harvey J, Albrecht JK. Clinical and economic implications of a 4-week viral negative response to peginterferon alfa-2b plus ribavirin for chronic hepatitis C and genotype 1 and low viral load [abstract 1224]. Presented at: 56th Annual Meeting of AASLD; November 11-15, 2005; San Francisco, Calif.

15. Davis GL, Wong JB, McHutchison JG, Manns MP. Early virological response to treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C. Hepatology 2003;38:645.

16. Buti M, Lurie Y, Sanchez F, Valdes A, Esteban R. Extending combination therapy with peginterferon alfa-2b plus ribavirin for genotype 1 chronic hepatitis C late responders: a report of 9 cases. Hepatology 2003;37:1226-7.

17. Berg T, Von Wagner M, Nasser S, Sarrazin C, Heintges T, Gerlach T, et al. Extended treatment duration for Hepatitis C Virus Genotype 1: Comparing 48 versus 72 weeks of Peginterferon alfa-2a plus ribavirin. Gastroenterology 2006;130:1086-97.

18. Sanchez-Tapias JM, Diago M, Escartin P, Enriquez J, Moreno R, Romero-Gomez M, et al. Longer treatment duration with peginterferon alfa2a and ribavirin in naïve patients with chronic hepatitis C and detectable HCV RNA by week 4 of therapy: final results of the randomized multicenter Tevaric-4 study. Hepatology 2004;40 (S4):216A.

 

 

(1) Serviço de Doenças Infecciosas, Hospitais da Universidade de Coimbra, Portugal

 

Correspondência:

Nuno Marques

Serviço de Doenças Infecciosas,

Hospitais da Universidade de Coimbra

Praceta Prof. Mota Pinto

3000-075 Coimbra

Tel.: (+351) 239400402

Fax: (+351) 239402007

e-mail: lusonmar@hotmail.com

Recebido para publicação: 11/09/2007

Aceite para publicação: 21/11/2007