ABSTRACT
Abstract: Background and aims. Pegylated interferon (Peg-INF) and ribavirin (RBV) based therapy is suboptimal and poorly tolerated. We evaluated the safety, tolerability and efficacy of a 24-week course of sofosbuvir plus daclatasvir without ribavirin for the treatment of hepatitis C virus (HCV) recurrence after liver transplantation (LT) in both HCV-monoinfected and human immunodeficiency virus (HIV)-HCV coinfected patients. Material and methods. We retrospectively evaluated 22 consecutive adult LT recipients (16 monoinfected and 6 coinfected with HIV) who received a 24-week course of sofosbuvir plus daclatasvir treatment under an international compassionate access program. Results. Most patients were male (86%), with a median age of 58 years (r:58-81y). Median time from LT to treatment onset was 70 months (r: 20-116 m). HCV genotype 1b was the most frequent (45%), 55% had not responded to previous treatment with Peg-INF and RBV and 14% to regiments including first generation protease inhibitors. Fifty-six percent of the patients had histologically proven cirrhosis and 6 had ascites at baseline. All patients completed the 24-week treatment course without significant side effects except for one episode of severe bradicardya, with only minor adjustments in immunosuppressive treatment in some cases. Viral suppression was very rapid with undetectable HCV-RNA in all patients at 12 weeks. All 22 patients achieved a sustained virological response 12 weeks after treatment completion. Conclusion. The combination of sofosbuvir plus daclatasvir without ribavirin is a safe and effective treatment of HCV recurrence after LT in both monoinfected and HIV-coinfected patients, including those with decompensated cirrhosis.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Antiviral Agents/administration & dosage , HIV Infections/virology , Liver Transplantation/adverse effects , Hepatitis C/drug therapy , Hepacivirus/drug effects , End Stage Liver Disease/surgery , Coinfection , Sofosbuvir/administration & dosage , Imidazoles/administration & dosage , Liver Cirrhosis/drug therapy , Antiviral Agents/adverse effects , Recurrence , Time Factors , Virus Activation , RNA, Viral/genetics , Drug Administration Schedule , HIV Infections/diagnosis , Retrospective Studies , Treatment Outcome , Hepatitis C/diagnosis , Hepatitis C/virology , Hepacivirus/genetics , Hepacivirus/pathogenicity , Viral Load , Drug Therapy, Combination , Compassionate Use Trials , End Stage Liver Disease/diagnosis , End Stage Liver Disease/virology , Sofosbuvir/adverse effects , Imidazoles/adverse effects , Immunosuppressive Agents/administration & dosage , Liver Cirrhosis/diagnosis , Liver Cirrhosis/virologyABSTRACT
Se presenta un paciente masculino, quien presentó un adenocarcinoma ductal infiltrante de mama, y quien fuera atendido en el Servicio de Cirugía 2, Servicio Autónomo Hospital Central de Maracay, Venezuela. Paciente masculino de 57 años de edad quien inició su enfermedad actual 3 meses antes de su ingreso con nódulos del 1 cm de diámetro, retroereolar izquierda, no doloroso, el cual, tiene un crecimiento rápido hasta alcanzar 5 cm x 5 cm de diámetro. Posteriormente dicha lesión se ulcera, drenando exudado serohemático en moderada cantidad, motivo por el cual consulta y le realizan biopsia que reporto carcinoma ductal infiltrante. Se realizó mastectomía radical izquierda, evidenciando lesión ulcerada de 4 cm de diámetro que infiltra hasta aponeurosis del pectoral mayor. Además de plastrón ganglionar con ganglios de 1 cm de diámetro, de consistencia aumentada. Se presenta el caso debido a lo infrecuente de encontrar adenocarcinoma de mama en un hombre. Los pacientes con cáncer de mama pueden ser sometidos a procedimientos quirúrgicos que van desde el extremo conservador de una tumorectomía hasta el opuesto de una mastectomía radical, dependiendo del criterio o preferencia del cirujano