Tratamiento de infección por virus hepatitis C con nuevos antivirales en pediatría: a propósito de un caso / Treatment of hepatitis C virus infection with new direct-acting antivirals agents in pediatrics. Case report

La infección por virus de la hepatitis C en pediatría se produce principalmente por transmisión vertical. La historia natural en niños consiste en alta tasa de eliminación espontánea, infección asintomática o cambios histológicos mínimos. Las complicaciones suelen observarse en la adolescencia o en la edad adulta. El tratamiento clásico con interferón pegilado y ribavirina presenta efectos adversos, es de duración prolongada y logra una respuesta virológica sostenida (RVS) en el 50 % de los pacientes con infección por genotipo 1. Los nuevos antivirales de acción directa se encuentran disponibles para su indicación a partir de los 12 años, con excelente tolerancia y alta tasa de RVS. Se sugiere conducta terapéutica expectante en pacientes asintomáticos hasta acceder a la medicación. Reportamos el caso de un adolescente con hepatitis C crónica sin cirrosis que recibió tratamiento durante 12 semanas con ledipasvir/sofosbuvir y se logró una RVS.

Hepatitis C virus infection in children occurs mainly through vertical transmission. The natural history at this age consists in a high rate of spontaneous clearance, asymptomatic infection, or minimal histological changes. Disease complications are commonly seen in adolescence or adulthood. The classic treatment with pegylated interferon and ribavirin presents adverse effects, prolonged duration and achieves sustained viral response (SVR) in 50 % of patients with genotype 1 infection (the most frequent). New direct-acting antiviral treatments have been available in recent years for their indication from 12 years of age with excellent tolerance and a high SVR rate. Expectant therapeutic behavior is suggested in asymptomatic patients until they can access to them. We report the case of an adolescent with chronic hepatitis C without cirrhosis who received 12 weeks treatment with ledipasvir/sofosbuvir, achieving SVR.

Combination of Ledipasvir and Sofosbuvir for Treatment of Hepatitis C Virus Genotype 1 Infection: Systematic Review and Meta-Analysis

ABSTRACT Background and aim. The combination of Sofosbuvir (SOF) and Ledipasvir (LDV) has been lead to considerable enhancement of treatment of hepatitis C virus (HCV) genotype 1 infection. A meta-analysis of the currently available studies was undertaken with the aim to evaluate the antiviral efficacy of SOF/LDV therapy for 12 or 24 weeks with or without Ribavirin (RBV) in patients with HCV genotype 1 infection. Material and methods. In this meta-analysis, we searched databases including PubMed, Scopus, Science Direct and Web of Science using appropriate keywords. All papers which evaluated the efficacy of combination therapy of SOF/LDV with or without RBV for 12 or 24 weeks among patients with HCV genotype 1 infection were included. Results. The 20 published articles were assessed for eligibility and finally 10 articles pooling 2248 participants were included in this meta-analysis. Pooled SVR12 for four SOF/LDV regimens were 95% (95%CI = 93%-97%) for 12 weeks of treatment with SOF/LDV, 97% (95%CI = 95%-98%) for 24 weeks of treatment with SOF/LDV, 96% (95%CI = 94%-97%) for 12 weeks of treatment with SOF/ LDV/RBV and 98% (95%CI = 97%-99%) for 24 weeks of treatment with SOF/LDV/RBV. Only in treatment regimen of SOF/LDV for 12 weeks, cirrhosis had a significant effect on the SVR12 (OR = 0.21, 95%CI = 0.07-0.66). Furthermore, NS5A resistance-associated substitutions at baseline were associated with decrease in the rate of SVR (OR = 0.31, 95%CI = 0.2-0.5). Conclusions. The Interferon-free regimen of SOF/LDV for 12 or 24 weeks with or without RBV is highly effective for treatment of patients with HCV genotype 1 infection.

Hope for Cirrhosis Patients with Genotype 1 Hepatitis C Virus Who Failed the Previous Treatment / 대한소화기학회지

No abstract available.

Evidence of an increased incidence of day 3 parasitaemia in Suriname: an indicator of the emerging resistance of Plasmodium falciparum to artemether

The emerging resistance to artemisinin derivatives that has been reported in South-East Asia led us to assess the efficacy of artemether-lumefantrine as the first line therapy for uncomplicated Plasmodium falciparum infections in Suriname. This drug assessment was performed according to the recommendations of the World Health Organization in 2011. The decreasing number of malaria cases in Suriname, which are currently limited to migrating populations and gold miners, precludes any conclusions on artemether efficacy because adequate numbers of patients with 28-day follow-up data are difficult to obtain. Therefore, a comparison of day 3 parasitaemia in a 2011 study and in a 2005/2006 study was used to detect the emergence of resistance to artemether. The prevalence of day 3 parasitaemia was assessed in a study in 2011 and was compared to that in a study in 2005/2006. The same protocol was used in both studies and artemether-lumefantrine was the study drug. Of 48 evaluable patients in 2011, 15 (31%) still had parasitaemia on day 3 compared to one (2%) out of 45 evaluable patients in 2005/2006. Overall, 11 evaluable patients in the 2011 study who were followed up until day 28 had negative slides and similar findings were obtained in all 38 evaluable patients in the 2005/2006 study. The significantly increased incidence of parasite persistence on day 3 may be an indication of emerging resistance to artemether.

Phase II trial in China of a new, rapidly-acting and effective oral antimalarial, CGP 56697, for the treatment of Plasmodium falciparum malaria.

One hundred and two Chinese out-patients with naturally acquired, previously untreated, falciparum malaria were selected to evaluate the efficacy of a new combination anti-malaria therapy, CGP 56697 (artemether plus benflumetol). In this open non-comparative trial each patient received a combination of 80 mg artemether and 480 mg benflumetol given orally at 0, 8, 24 and 48 hours (total: 320 mg artemether, 1,920 mg benflumetol). Patients were kept for 28 days in a transmission-free hospital in an area with chloroquine resistant falciparum malaria to prevent reinfection and to aid diagnosis of recrudescence. Progress and possible adverse effects were monitored by blood film parasitology, blood biochemistry assays, urinalysis, ECG and X-ray. Ninety-eight of the 102 patients were shown to be free of infection at 28 days, a 96.1% cure rate. Parasite reduction at 24 hours was 99.4%. Time to effect complete parasite clearance ranged from 24 to 54 hours (median 30 hours). Time for fever clearance ranged from 6 to 78 hours (median 18 hours). Recrudescence was low (3.9%). No significant adverse side-effects were encountered. It is concluded that CGP 56697, a combination anti-malaria therapy of artemether with benflumetol, offered a rapid and highly effective treatment for acute uncomplicated falciparum malaria in an area of chloroquine-resistant malaria in China.