ABSTRACT
Background: unlike human immunodeficiency virus [HIV] and hepatitis B virus [HBV], hepatitis C virus [HCV] infection is a curable disease. Current direct acting antiviral agent [DAA] targets are focused on HCV NS3/4A protein [protease], NS5B protein [polymerase] and NS5A protein. The first generation of DAAs includes boceprevir and telaprevir, which are protease inhibitors and were approved for clinical use in 2011. The cure rate for genotype 1 patients increased from 45% to 70% when boceprevir or telaprevir was added to standard PEG-IFN/ribavirin. More effective and less toxic second generation DAAs supplanted these drugs by 2013. The second generation of DAAs includes sofosbuvir, simeprevir and fixed combination medicines containing ledipasvir plus sofosbuvir and Viekira Pak. These drugs increase cure rates to over 90% without the need for interferon and effectively treat all HCV genotypes. With these drugs the "cure HCV" goal has become a reality. The aim of this study was to assess of ledipasvir plus sofosbuvir as treatment of HCV infection in patients with advanced liver disease including cirrhotic patients with child B and C
Patients and methods: in this prospective study, seventy five HCV PCR positive patients were classified into three groups according to child score. Each group included twenty five patients. All patients received ledipasvir plus sofosbuvir for six months. For all patients thorough medical history, clinical examination, kidney function tests, liver function tests, complete blood count, pelvi-abdominal ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative, HbsAg, alpha fetoprotein as baseline screening. HCV PCR done for all patients at end of treatment and three months later to detect sustained virological response [SVR12]. Patients with combined HCV and HBV infection, hepatic or extrahepatic malignancies and late child C were excluded
Results: showed that no statistical significant difference were detected in patients of group A as regard liver function tests before and after treatment and SVR12 achieved by 96%. Patients of group B showed significant statistical difference as regard liver function tests before and after treatment with SVR12 achieved by 88%. In patients of group C there were significant statistical difference in liver function tests with SVR12 achieved by 80%. Also there were clinical improvement in patients of group B and C after end of treatment
Conclusion: it could be concluded that there will be a dramatic improvement in HCV therapy followed the introduction of oral medicines that directly inhibiting the replication cycle of HCV. The combination pill contains a fixed-dose of ledipasvir 90 mg and sofosbuvir 400 mg, two direct-acting antiviral agents against HCV. Ledipasvir is an inhibitor of the NS5A protein, which is required for HCV replication. Sofosbuvir inhibits the HCV NS5B RNA-dependent RNA polymerase, which is also required for viral replication. Sofosbuvir is a nucleotide prodrug that undergoes intracellular metabolism to form a pharmacologically active triphosphate that can incorporate into the HCV RNA. Ledipasvir plus sofosbuvir can be used safely in treatment of compensated and decompensated post hepatitis C liver cirrhosis. SVR12 can be achieved by 96% in patients with early cirrhosis [child A], 88% in patients with child B cirrhosis and 80% in patients with child C with subsequent improvement in liver functions
ABSTRACT
Background: Occult hepatitis C virus infection [OCI] was identified as Hepatitis C virus [HCV], characterized by undetectable HCV antibodies and HCV RNA in serum, while HCV RNA is detectable in liver and peripheral blood mononuclear cells [PBMCs] only. Nosocomial transmission in dialysis units maintains a higher prevalence of hepatitis C virus [HCV] infection in patients on maintenance dialysis than in the general population. HCV infection has a detrimental effect on survival in patients on maintenance dialysis and after renal transplantation. The excess risk for death in HCV-positive patients was partially attributed to chronic liver disease with its attendant complications, particularly hepatocellular carcinoma and liver cirrhosis
The aim of this study: was to evaluate the hidden infection of hepatitis C virus among regular hemodialysis patients in Bab Al Sharia University Hospital with negative ELISA and PCR by using PCR in mononuclear cells as a marker in the serum of these patients
Patients and methods:in this prospective study, 60 patients with end-stage renal disease on regular hemodialysis [for at least 6 months duration] were included. For all patients thorough medical history, clinical examination, kidney function tests, liver function tests, complete blood count, pelvi-abdominal ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative, HbsAg,. HCV PCR done for all patients in serum and mononuclear cells.. Patients with acute or chronic HCV infection as marked by positive hepatitis C antibody,acute or chronic HBV infections marked by hepatitis B surface antigen,other causes of liver dysfunction [e.g., primary biliary cirrhosis, autoimmune hepatitis, HIV infection] and patient on anti HCV treatment.were excluded
Results: showed detection of HCV-PCR in PBMCs in the absence of HCV-PCR in plasma; was found in three of the 60 patients [3.3%]. All patients had negative HIV, HBsAg, HCV Ab and serum HCV PCR
Conclusion: it could be concluded that testing for HCV-RNA in PBMCs is more reliable than hepatitis serological markers in identifying patients with an OCI when a liver biopsy is not available