Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 178
Filter
1.
Evid. actual. práct. ambul ; 25(2): e007014, 2022. ilus, tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1380221

ABSTRACT

El nuevo tratamiento simplificado con antivirales orales para pacientes con Hepatitis C puede ser abordado desde la atención primaria, lo que facilita el acceso de la población afectada por esta infección crónica. En este artículo se repasan los aspectos claves del diagnóstico, el esquema de tratamiento simplificado y los candidatos a recibirlo. (AU)


The new simplified treatment with oral antivirals for hepatitis C patients can be approached at the primary care level, facilitating access for the population affected by this chronic infection. This article reviews the key aspects of the diagnosis, the simplified treatment scheme, and the eligible candidates for the treatment. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Antiviral Agents/administration & dosage , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Primary Health Care , Enzyme-Linked Immunosorbent Assay , Hepatitis C/blood , Persistent Infection/diagnosis , Persistent Infection/drug therapy , Persistent Infection/blood , Liver Cirrhosis/diagnosis
2.
Braz. J. Pharm. Sci. (Online) ; 58: e19736, 2022. tab, graf
Article in English | LILACS | ID: biblio-1383992

ABSTRACT

Abstract Bacillus species are promising producers of various compounds that have pronounced antimicrobial, antiviral and antitumor activities. Due to its GRAS status, Bacillus subtilis represents an excellent candidate for the usage in plant pathogens biocontrol. In this research, evaluation of antifungal metabolites biosynthesis by Bacillus subtilis ATCC 6633 and optimization of glycerol-based medium composition, using response surface methodology, for the production of compounds effective against Neurospora crassa were investigated. The results of disc-diffusion method indicate that applied Bacillus strain produces compounds with antifungal activity against tested fungus. In order to find optimal cultivation medium composition, the experiments were carried out in accordance with Box-Behnken design, and optimization was performed using the concept of desirability function combined with previously defined mathematical equation, which describes examined bioprocess. The optimization model predicts that maximum inhibition zone diameter against Neurospora crassa of 32.24 mm is achieved when initial content of glycerol, NaNO2 and K2HPO4 were 49.68 g/L, 2.90 g/L and 6.49 g/L, respectively. Additionally, the second optimization set was made to minimize the consumption of medium components and costs of medium preparation. The obtained results are the basis for further research aimed to develop medium appropriate for economically justified production of bioactive compounds at industrial scale.


Subject(s)
Bacillus subtilis/metabolism , Process Optimization , Glycerol/analogs & derivatives , Antiviral Agents/administration & dosage , Costs and Cost Analysis/classification , Methodology as a Subject , Evaluation Studies as Topic
4.
Rev. chil. enferm. respir ; 37(2): 139-148, jun. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388143

ABSTRACT

Resumen Desde la notificación de la pandemia por SARS-CoV-2, agente patógeno responsable del COVID-19, muchos de los tratamientos dirigidos a su manejo han estado sometidos a estudios de manera constante, con el fin de comprobar su eficacia y seguridad. El conocimiento de su virología y etiopatogenia posibilitaría objetivar los pasos moleculares específicos que puedan ser blancos terapéuticos de variados fármacos actualmente disponibles. Esta experiencia proviene principalmente de las infecciones por SARS-CoV y MERS-CoV, con resultados variados 'in vitro' en el SARS-CoV-2, sin evidencia clínica que demuestre efectividad y seguridad de dichos tratamientos. A la fecha, no se ha podido concretar con claridad un esquema de tratamiento específico, debido a que la evidencia surgida ha puesto en jaque cada uno de los fármacos propuestos. Esto ha motivado a continuar en la búsqueda de una estrategia efectiva que permita manejar esta pandemia con la seguridad y eficacia necesaria para que el beneficio terapéutico esté por sobre los posibles efectos adversos que estos esquemas farmacológicos pudiesen presentar. La siguiente revisión pretende mostrar la evidencia disponible a la fecha, definiendo la actividad de cada fármaco en función de su mecanismo de acción.


Since the beginning of the pandemic by SARS-CoV-2, the pathogen responsible for COVID-19, many of the therapeutic options for its management have been under constant revision, in order to verify their safety and efficiency. Knowledge of the viral structure and pathogenesis make it possible to determine the molecular pathways that may be targeted with current available drugs. The experience with these drugs comes mainly from infections caused by SARS-CoV and MERS-CoV, in vitro studies with SARS-CoV-2 that yield variable results, and clinical experience that does not ensure effectiveness and safety of such drugs. To date, it has not been possible to elucidate a specific treatment scheme, because of the constant release of evidence that challenges the usefulness of the proposed drugs. This has motived us to continue seeking for an effective strategy that allows to manage this pandemic in a safe and efficient manner, so that therapeutic benefit surpasses the related adverse drug reactions that can occur. The following review aims to showcase the evidence available to date by defining the activity of each drug based on its mechanism of action.


Subject(s)
Humans , Antiviral Agents/administration & dosage , SARS-CoV-2/drug effects , COVID-19/drug therapy , Plasma , Ivermectin/administration & dosage , Adenosine Monophosphate/analogs & derivatives , Chloroquine/administration & dosage , Interleukin-6/antagonists & inhibitors , Interleukin-1/antagonists & inhibitors , Interferon-beta/administration & dosage , Adrenal Cortex Hormones/administration & dosage , Ritonavir/administration & dosage , Alanine/analogs & derivatives , Lopinavir/administration & dosage , Anticoagulants/administration & dosage
5.
Gac. méd. Méx ; 156(6): 580-585, nov.-dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1249970

ABSTRACT

Resumen El virus SARS-CoV-2 ha sido identificado como el agente patológico causante de la pandemia de COVID-19. Aun cuando no se cuenta con un tratamiento estándar, se han probado antivirales como remdesivir y otros fármacos como cloroquina e ivermectina, que interfieren con la replicación del virus. También se han intentado algunas estrategias encaminadas a disminuir los mecanismos inmunitarios, como el uso de tocilizumab y antioxidantes naturales. Los fármacos relacionados con el sistema renina-angiotensina han resultado controversiales. Aún se debe estudiar con detalle los mecanismos de patogenicidad, así como los tratamientos controlados para proponer alguna opción terapéutica viable que evite la entrada y replicación del virus o que aumente los sistemas inmunitarios del huésped.


Abstract SARS-CoV-2 virus has been identified as the causative agent of the COVID-19 pandemic. Even when no standard treatment is available, antivirals such as remdesivir and other drugs such as chloroquine and ivermectin, which interfere with viral replication, have been assayed. Some strategies aimed to reduce immune mechanisms, such as the use of tocilizumab and natural antioxidants, have also been tested. The use of drugs related to the renin-angiotensin system has been controversial. Pathogenicity mechanisms, as well as controlled treatments, still have to be studied in detail in order to propose a viable therapeutic option that prevents the entry and replication of the virus or enhances the host immune system.


Subject(s)
Humans , Animals , Antiviral Agents/administration & dosage , COVID-19/drug therapy , Antiviral Agents/pharmacology , Virus Replication/drug effects , Virus Internalization/drug effects , SARS-CoV-2/isolation & purification , SARS-CoV-2/drug effects , COVID-19/virology
6.
Medwave ; 20(6): e7967, 31-07-2020.
Article in English | LILACS | ID: biblio-1119705

ABSTRACT

Objective: Provide a timely, rigorous, and continuously updated summary of the evidence on the role of lopinavir/ritonavir in the treatment of patients with COVID-19. Methods: We conducted searches in the special L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs regular searches in PubMed, Embase, CENTRAL, and other 33 sources. We searched for randomized trials and non-randomized studies evaluating the effect of lopinavir/ritonavir versus placebo or no treatment in patients with COVID-19. Two reviewers independently evaluated potentially eligible studies, according to predefined selection criteria, and extracted data using a predesigned standardized form. We performed meta-analyses using random-effect models and assessed overall certainty in evidence using the GRADE approach. A living, web-based version of this review will be openly available during the COVID-19 pandemic. Results: Our search strategy yielded 862 references. Finally, we identified 12 studies, including two randomized trials, evaluating lopinavir/ritonavir, in addition to standard care versus standard care alone in 250 adult inpatients with COVID-19. The evidence from randomized trials shows lopinavir/ritonavir may reduce mortality (relative risk: 0.77; 95% confidence interval: 0.45 to 1.3; low certainty evidence), but the anticipated magnitude of the absolute reduction in mortality, varies across different risk groups. Lopinavir/ritonavir also had a slight reduction in the risk of requiring invasive mechanical ventilation, developing respiratory failure, or acute respiratory distress syndrome. However, it did not lead to any difference in the duration of hospitalization and may lead to an increase in the number of total adverse effects. The overall certainty of the evidence was low or very low. Conclusions: For severe and critical patients with COVID-19, lopinavir/ritonavir might play a role in improving outcomes, but the available evidence is still limited. A substantial number of ongoing studies should provide valuable evidence to inform researchers and decision-makers soon.


Objetivo: Esta revisión sistemática viva tiene como objetivo entregar un resumen oportuno, riguroso y constantemente actualizado de la evidencia disponible sobre los efectos de lopinavir/ritonavir en pacientes con COVID-19. Métodos: Se realizó una búsqueda en la plataforma L·OVE COVID-19 (Living OVerview of Evidence), un sistema que mantiene búsquedas regulares en PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) y otras 33 fuentes. Se buscaron ensayos aleatorios y estudios no aleatorios que evaluaran el uso de lopinavir/ritonavir versus placebo o ningún tratamiento en pacientes con COVID-19. Dos revisores evaluaron de forma independiente los artículos potencialmente elegibles, de acuerdo con criterios de selección predefinidos, y extrajeron los datos mediante un formulario estandarizado. Los resultados fueron combinados mediante un metanálisis utilizando modelos de efectos aleatorios y evaluamos la certeza de la evidencia utilizando el método GRADE. Una versión viva de esta revisión estará disponible durante la pandemia de COVID-19. Resultados: La búsqueda inicial arrojó 862 referencias. Finalmente, identificamos 12 estudios incluyendo 2 ensayos aleatorios, que evaluaban lopinavir/ritonavir adicionado al tratamiento estándar versus tratamiento estándar en 250 pacientes adultos hospitalizados con COVID-19. Los resultados provenientes de los ensayos aleatorios muestran que el uso de lopinavir/ritonavir puede reducir la mortalidad (riesgo relativo: 0,77; intervalo de confianza 95%: 0,45 a 1,3; certeza de evidencia baja), pero la magnitud de la reducción absoluta de la mortalidad varía según los diferentes grupos de riesgo. El uso de lopinavir/ritonavir mostró además una ligera reducción en el riesgo de requerir ventilación mecánica invasiva, desarrollar insuficiencia respiratoria o síndrome de dificultad respiratoria aguda. No se observó diferencias en la duración de la hospitalización y su uso puede producir un aumento en el número de efectos adversos totales. La certeza global de la evidencia fue baja o muy baja. Conclusiones: Para pacientes graves y críticos con COVID-19, el uso de lopinavir/ritonavir podría desempeñar un papel en la mejora de los resultados, pero la evidencia disponible aún es limitada. La gran cantidad de estudios en curso deberían proporcionar evidencia valiosa para informar a los investigadores y los tomadores de decisiones en el futuro cercano.


Subject(s)
Humans , Adult , Antiviral Agents/administration & dosage , Ritonavir/administration & dosage , Lopinavir/administration & dosage , COVID-19/drug therapy , Antiviral Agents/adverse effects , Randomized Controlled Trials as Topic , Treatment Outcome , Ritonavir/adverse effects , Drug Combinations , Pandemics , Lopinavir/adverse effects
7.
J. bras. nefrol ; 42(2): 182-190, Apr.-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1134820

ABSTRACT

ABSTRACT Introduction: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. Methods: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospital admission, and clinical evaluation. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction. Results: The 12 patients who had H1N1 infection did not differ significantly from the other 50 non-infected patients with respect to age, sex, dialysis vintage, dialysis modality, or proportion of comorbidities. Obesity was higher in the H1N1-infected group (41.5 vs. 4%, p<0.002). The most common symptoms were fever (92%), cough (92%), and rhinorrhea (83%). Early empirical antiviral treatment with oseltamivir was started in symptomatic patients and infection control measures, including the intensification of contact-reduction measures by the staff members, antiviral chemoprophylaxis to asymptomatic patients undergoing HD in the same shift of infected patients, and dismiss of staff members suspected of being infected, were implemented to control the spread of infection in the dialysis unit. Conclusion: The clinical course of infection with H1N1 in our patients was favorable. None of the patients developed severe disease and the strategies adopted to control the outbreak were successful.


RESUMO Introdução: Pacientes em hemodiálise (HD) crônica apresentam risco elevado para infecções. O presente estudo descreve os desfechos clínicos de pacientes em HD crônica com infecção pelo vírus influenza A (H1N1) e as estratégias adotadas para controlar um surto de influenza A numa unidade de diálise. Métodos: Doze (19,4%) de 62 pacientes em HD crônica e quatro (12,5%) de 32 funcionários desta unidade de diálise apresentaram infecção pelo vírus H1N1. Os desfechos incluíram sintomas à apresentação, comorbidades, ocorrência de hipoxemia, internação hospitalar e avaliação clínica. A presença de infecção foi confirmada por reação em cadeia da polimerase via transcriptase reversa (RT-PCR) em tempo real. Resultados: Os 12 pacientes com infecção por H1N1 não diferiram significativamente dos 50 pacientes sem infecção no tocante a idade, sexo, tempo em diálise, modalidade de diálise e percentual de comorbidades. O percentual de obesidade foi mais elevado no grupo com infecção por H1N1 (41,5% vs. 4%, p<0,002). Os sintomas mais comuns foram febre (92%), tosse (92%) e rinorreia (83%). Os pacientes foram submetidos a tratamento antiviral com oseltamivir e medidas de controle (intensificação das medidas de redução de contato pelos funcionários da clínica, quimioprofilaxia com antiviral para pacientes assintomáticos em HD na mesma sala dos pacientes com infecção e afastamento de funcionários da clínica com suspeita de infecção) para controlar a disseminação da infecção pela unidade de diálise. Conclusão: O curso clínico da infecção por H1N1 em nossos pacientes foi favorável. Nenhum evoluiu para doença grave e as estratégias adotadas foram efetivas no controle do surto.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Antiviral Agents/administration & dosage , Influenza Vaccines/administration & dosage , Disease Outbreaks/prevention & control , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Influenza A Virus, H1N1 Subtype/genetics , Brazil/epidemiology , Comorbidity , Retrospective Studies , Renal Dialysis , Vaccination/methods , Treatment Outcome , Reverse Transcriptase Polymerase Chain Reaction , Influenza, Human/prevention & control , Influenza, Human/virology , Oseltamivir/administration & dosage , Real-Time Polymerase Chain Reaction
8.
Rev. cuba. oftalmol ; 33(1): e837, ene.-mar. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126717

ABSTRACT

RESUMEN Objetivo: Identificar el resultado óptico o terapéutico de la queratoplastia penetrante en pacientes con queratopatía herpética. Métodos: Se realizó una investigación descriptiva, transversal, donde se expusieron los resultados del alcance de la queratoplastia penetrante por queratopatía herpética, operados en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras", de La Habana. Resultados: La muestra fue de 33 queratoplastias penetrantes. Con fines ópticos sumaron 24 (72,7 por ciento) y tectónicas 9 (27,3 por ciento). En 5 de estas la agudeza visual fue menor o igual a 0,3. En el total de la muestra, 9 opacificaron, 11 sufrieron complicaciones posquirúrgicas, 8 recurrieron en queratoplastias penetrantes ópticas y 6 en queratoplastias penetrantes terapéuticas. Se rechazaron 7 queratoplastias penetrantes ópticas (33,3 por ciento) y 4 queratoplastias penetrantes terapéuticas (4 por ciento). Presentaron complicaciones 5 (25 por ciento) con queratoplastias penetrantes ópticas y 6 (55,6 por ciento) con queratoplastias penetrantes terapéuticas. En el posquirúrgico 22 (66,6 por ciento) tenían agudeza visual mayor o igual a 0,3 (p= 0,0000). Conclusiones: La inactividad de la enfermedad viral corneal beneficia el pronóstico del injerto por queratopatía herpética en las opacidades de las queratoplastias con fines ópticos. Queda demostrado que el uso de antivirales pre y posoperatorios disminuye la recidiva de la enfermedad herpética sobre el injerto y el rechazo, al lograr mejor agudeza visual y mayor viabilidad. La severidad inflamatoria posquirúrgica se asocia con la enfermedad viral activa o afección de origen inmune al realizar el trasplante, conexos a las complicaciones post queratoplastia(AU)


ABSTRACT Objective: Identify the optical or therapeutic outcome of penetrating keratoplasty in patients with herpetic keratopathy. Methods: A descriptive cross-sectional study was conducted in which a presentation was made of the results of the scope of penetrating keratoplasties for herpetic keratopathy performed at Hermanos Ameijeiras Clinical Surgical Hospital in Havana. Results: The sample was 33 penetrating keratoplasties: 24 optical (72.7 percent) and 9 tectonic (27.3 percent). Visual acuity was lower than or equal to 0.3 in 5 of them. Of the total sample, 9 opacified, 11 had postoperative complications, 8 recurred in optical penetrating keratoplasties, and 6 in therapeutic penetrating keratoplasties. Rejection occurred in 7 optical penetrating keratoplasties (33.3 percent) and 4 therapeutic penetrating keratoplasties (4%). Complications were observed in 5 (25 percent) optical penetrating keratoplasties and 6 (55.6 percent) therapeutic penetrating keratoplasties. In the postoperative period 22 (66.6 percent) had a visual acuity greater than or equal to 0.3 (p= 0.0000). Conclusions: Inactivity of corneal viral disease benefits the prognosis of grafting due to herpetic keratopathy in opacities of optical keratoplasties. Pre- and postoperative antivirals were found to reduce the recurrence of herpetic disease on the graft and rejection, achieving better visual acuity and greater viability. Postoperative inflammatory severity is associated to an active viral disease or an immune disorder at the time of the grafting resulting in post keratoplasty complications(AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Antiviral Agents/administration & dosage , Postoperative Complications/therapy , Corneal Transplantation/adverse effects , Keratoplasty, Penetrating/adverse effects , Epidemiology, Descriptive , Cross-Sectional Studies
9.
Arq. gastroenterol ; 57(1): 45-49, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1098060

ABSTRACT

ABSTRACT BACKGROUND: Direct-acting antivirals have revolutionized hepatitis C treatment, also for patients with chronic kidney disease (CKD), but some controversy exists regarding the use of sofosbuvir (SOF) in patients with glomerular filtration rate (GFR) <30 mL/min. OBJECTIVE: To evaluate the efficacy and safety of these regimens for hepatitis C treatment of patients with CKD and after renal transplantation, as well as the impact of SOF on renal function in non-dialysis patients. METHODS: All patients with hepatitis C and CKD or renal transplant treated with direct-acting antivirals at a referral center in Brazil between January 2016 and August 2017 were included. Efficacy was evaluated based on viral load (HCV RNA) and a sustained virological response (SVR) consisting of undetectable RNA 12 and/or 24 weeks after the end of treatment (SVR12 and SVR24) was defined as cure. Safety was determined by adverse events and ribavirin, when combined, was administered in escalating doses to all patients with GFR <60 mL/min. The impact of SOF on renal function was determined by the measurement of baseline creatinine during and after the end of treatment and its increase was evaluated using the Acute Kidney Injury Network (AKIN) classification. RESULTS: A total of 241 patients (52.7% females) with a mean age of 60.72±10.47 years were included. The combination of SOF+daclatasvir was the predominant regimen in 75.6% of cases and anemia was present in 28% of patients who used ribavirin (P=0.04). The SVR12 and SVR24 rates were 99.3% and 97.1%, respectively. The treatment was well tolerated and there were no major clinically relevant adverse events, with the most prevalent being asthenia (57.7%), itching (41.1%), headache (40.7%), and irritability (40.2%). Among conservatively treated and renal transplant patients, oscillations of creatinine levels (AKIN I) were observed in 12.5% of cases during treatment and persisted in only 8.5% after the end of treatment. Of these, 2.0% had an initial GFR <30 mL/min and this percentage decreased to 1.1% after SOF use. Only 0.5% and 1.6% of the patients progressed to AKIN II and AKIN III elevation, respectively. CONCLUSION: The direct-acting antivirals were safe and efficacious in CKD patients treated with SOF-containing regimens, with the observation of high SVR rates, good tolerability and few severe adverse events. The combination with ribavirin increased the risk of anemia and the administration of escalating doses seems to be useful in patients with GFR <60 mL/min. In patients with GFR <30 mL/min, SOF had no significant renal impact, with serum creatinine returning to levels close to baseline after treatment.


RESUMO CONTEXTO: Os antivirais de ação direta revolucionaram o tratamento da hepatite C, inclusive para os pacientes com doença renal crônica (DRC), porém ainda há divergências no emprego do sofosbuvir (SOF) quando taxa de filtração glomerular (TFG) <30 mL/min. OBJETIVO: Avaliar a eficácia e segurança desses esquemas no tratamento da hepatite C em pacientes com DRC e pós-transplante renal, além de avaliar o impacto do SOF sobre a função renal dos não-dialíticos. MÉTODOS: Todos os pacientes com hepatite C e DRC ou transplante renal que realizaram tratamento com antivirais de ação direta em centro referenciado do Brasil no período de janeiro/2016 a agosto/2017 foram incluídos. A eficácia foi avaliada por meio da carga viral (HCV-RNA), considerando-se cura uma resposta virológica sustentada (RVS) com resultado indetectável após 12 e/ou 24 semanas do término do tratamento (RVS12 e RVS24). A segurança foi determinada pelos eventos adversos e a ribavirina, quando associada, foi introduzida de forma escalonada em todos os pacientes com TFG <60 mL/min. Para determinação do impacto do SOF sobre a função renal, foram observadas as dosagens de creatinina basal, durante e após término do tratamento com seu incremento avaliado por meio da classificação de AKIN (acute kidney injury network). RESULTADOS: Foram incluídos 241 pacientes, sendo 52,7% do sexo feminino, com média de idade de 60,72±10,47 anos. A associação de SOF+daclatasvir predominou em 75,6% dos casos e anemia esteve presente em 28% dos pacientes que utilizaram ribavirina (P=0,040). As taxas de RVS12 e RVS24 foram de 99,3% e 97,1%. O tratamento foi bem tolerado, com eventos adversos pouco relevantes, sendo os mais prevalentes: astenia (57,7%), prurido (41,1%), cefaleia (40,7%) e irritabilidade (40,2%). Entre os pacientes em tratamento conservador e transplantados renais, os valores de creatinina sofreram oscilações AKIN I em 12,5% dos casos, durante o tratamento, persistindo em apenas 8,5% da amostra após o término, dos quais 2,0% apresentavam TFG <30 mL/min inicialmente, com queda para 1,1% após uso do SOF. Apenas 0,5% e 1,6% evoluíram com elevação AKIN II e AKIN III. CONCLUSÃO: Os antivirais de ação direta foram seguros e eficazes em pacientes com DRC tratados com esquemas contendo SOF, apresentando altas taxas de RVS, boa tolerabilidade e poucos eventos adversos graves. A associação com ribavirina aumentou o risco de anemia, portanto sua introdução de forma escalonada parece ser útil nos pacientes com TFG <60 mL/min. Em pacientes com TFG <30 mL/min o SOF não apresentou impacto renal significativo, com creatinina sérica retornando a valores próximos ao basal após o tratamento.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Antiviral Agents/administration & dosage , Kidney Transplantation/adverse effects , Hepacivirus/genetics , Hepatitis C, Chronic/drug therapy , Ribavirin/administration & dosage , Treatment Outcome , Viral Load , Drug Therapy, Combination , Renal Insufficiency, Chronic/surgery , Simeprevir/administration & dosage , Sofosbuvir/administration & dosage , Sustained Virologic Response , Genotype , Glomerular Filtration Rate/genetics , Imidazoles/administration & dosage , Middle Aged
10.
Arq. gastroenterol ; 57(1): 39-44, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1098056

ABSTRACT

ABSTRACT BACKGROUND: Hepatitis C virus (HCV) infection is the most common hepatotropic viral infection affecting the patients on maintenance hemodialysis. Treatment of chronic HCV infection in stage 4 and 5 CKD includes a combination of elbasvir/grazoprevir and glecaprevir/pibrentasvir, which are not available in many countries. OBJECTIVE: Hence, we have conducted this study to look for the safety and efficacy of sofosbuvir combination therapy in this difficult to treat population. METHODS: We conducted a single-center, prospective, open-label study in which Stage 5 CKD patients on maintenance hemodialysis with HCV infection. Total of 18 patients was included. sofosbuvir with daclatasvir or ledipasvir was used according to genotype for 12 weeks. HCV RNA, genotype, transient elastography (TE) was considered for every patient. HCV RNA was quantified at 4th week, 12th week and 12 weeks post-treatment to look for sustained virologic response (SVR 12). RESULTS: Infection due to genotype 1 was seen in 12 (66.7%) patients followed by genotype 3 in 4 (22.3%) with each patient of genotype 2 and 5. The median value of HCV RNA was 2,35,000 IU/mL. On TE, all had liver stiffness of <9.4 KPa. All patients had HCV RNA of <15 IU/mL at 4th and 12th week of treatment and 12 weeks post-treatment. No significant change in hemoglobin, eGFR and liver stiffness was observed. CONCLUSION: Full dose sofosbuvir i.e. 400 mg, in combination with NS5A inhibitors daclatasvir or ledipasvir is found to be safe and effective in patients with end stage renal disease, who are on maintenance hemodialysis.


RESUMO CONTEXTO: A infecção pelo vírus da hepatite C (HCV) é a infecção viral hepática mais comum que afeta pacientes em hemodiálise de manutenção. O tratamento da infecção crônica por HCV no estágio 4 e 5 da doença renal crônica inclui uma combinação de elbasvir/grazoprevir e glecaprevir/pibrentasvir, que não estão disponíveis em muitos países. OBJETIVO: Portanto, realizamos este estudo para procurar a segurança e eficácia da terapia combinada de sofosbuvir nesta população de difícil tratamento. MÉTODOS: Realizamos um estudo de centro único, prospectivo e aberto, no qual pacientes com doença renal crônica em estágio 5 em hemodiálise de manutenção com infecção por HCV. Um total de 18 pacientes foi incluído. Sofosbuvir com daclatasvir ou ledipasvir foi usado de acordo com o genótipo por 12 semanas. O HCV RNA, genótipo, elastografia transitória foi considerado para cada paciente. O HCV RNA foi quantificado na 4ª semana, 12ª semana e 12 semanas após o tratamento para procurar uma resposta virológica sustentada. RESULTADOS: A infecção por genótipo 1 foi observada em 12 (66,7%) pacientes, seguido pelo genótipo 3 em 4 (22,3%), em um paciente do genótipo 2 e em outro, 5. O valor mediano do HCV RNA foi de 2.35.000 IU/mL. Na elastografia transitória, todos tinham rigidez hepática de <9.4 KPa. Todos os pacientes tinham RNA HCV <15 IU/mL na 4ª e 12ª semana de tratamento e 12 semanas após o tratamento. Não foi observada nenhuma alteração significativa na hemoglobina, eGFR e rigidez hepática. CONCLUSÃO: A dose completa sofosbuvir ou seja, 400 mg, em combinação com inibidores NS5A daclatasvir ou ledipasvir foi considerada segura e eficaz em pacientes com doença renal em estágio final, que estão em manutenção hemodiálise.


Subject(s)
Humans , Male , Female , Adult , Antiviral Agents/administration & dosage , Hepatitis C, Chronic/drug therapy , 2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage , Fluorenes/administration & dosage , Sofosbuvir/administration & dosage , Imidazoles/administration & dosage , Severity of Illness Index , RNA, Viral , Prospective Studies , Renal Dialysis , Treatment Outcome , Hepacivirus/genetics , Drug Therapy, Combination , Sustained Virologic Response , Genotype , Middle Aged
11.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 38: e2018120, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057223

ABSTRACT

ABSTRACT Objective: To evaluate the trend of hospitalization for acute bronchiolitis in infants under one year of age, in the past eight years and after the implementation of the palivizumab immunization program in Brazil. Methods: The study is a retrospective analysis of data on infants younger than one year of age, who were hospitalized with acute bronchiolitis between 2008 and 2015 in Brazil. The Brazilian National Health System database was used. The rates of hospitalization in the pre-implementation (2008-2012) and post-implementation (2014-2015) periods of the palivizumab immunization program were evaluated. The total number of admissions in the same period was used as a comparison. Results: Between January 2008 and December 2015, 263,679 hospitalizations for bronchiolitis were recorded in infants younger than one year of age, 60% represented by boys. The incidence of hospitalization for bronchiolitis increased by 49% over this period (8.5 to 12.7 per 1,000 inhabitants per year). Between 2013 and 2014, the incidence rate of hospitalization for acute bronchiolitis decreased by 8% (12.5 to 11.5 per 1,000 inhabitants per year). However, in the second year of the program, hospitalization rate increased again by 10% (12.7 per 1,000 inhabitants per years). Conclusions: Acute bronchiolitis presented increasing rates of hospitalization over the study period. Hospitalization incidence for acute bronchiolitis declined one year after the implementation of palivizumab but increased again in the second year of the program.


RESUMO Objetivo: Avaliar a tendência de hospitalização por bronquiolite aguda (BA) em lactentes menores de um ano de idade nos últimos oito anos no Brasil e, secundariamente, após a implementação do programa de imunização por palivizumabe. Métodos: Análise retrospectiva dos dados de lactentes menores de um ano de idade, hospitalizados com diagnóstico de BA entre 2008 e 2015 no Brasil, utilizando o banco de dados do Sistema Único de Saúde (SUS). Foram avaliadas as taxas de hospitalização nos períodos pré-implementação (2008-2012) e pós-implementação (2014-2015) do programa de imunização por palivizumabe. O número total de internações no mesmo período foi utilizado como comparação. Resultados: Entre janeiro de 2008 e dezembro 2015 foram registradas 263.679 internações por bronquiolite em lactentes menores de um ano de idade, 60% representado por meninos. A incidência de hospitalização por bronquiolite aumentou em 49% ao longo desse período (8,5 para 12,7 por mil ­habitantes/­ano). Entre 2013 e 2014, a taxa de incidência de hospitalização por BA diminuiu 8% (12,5 para 11,5 por mil habitantes/ano). Porém, no segundo ano do programa, a taxa de internação aumentou novamente em 10% (12,7 por mil habitantes/ano). Conclusões: A BA apresentou taxas de hospitalização crescente ao longo do período estudado. A incidência de hospitalizações de BA apresentou declínio um ano após a implementação de palivizumabe e retornou à tendência crescente no segundo ano do programa.


Subject(s)
Humans , Male , Infant, Newborn , Infant , Antiviral Agents/therapeutic use , Bronchiolitis/drug therapy , Bronchiolitis/epidemiology , Palivizumab/therapeutic use , Hospitalization/trends , Antiviral Agents/administration & dosage , Respiratory Syncytial Viruses/immunology , Time Factors , Brazil/epidemiology , Bronchiolitis/immunology , Bronchiolitis/virology , Acute Disease , Incidence , Retrospective Studies , Respiratory Syncytial Virus Infections/prevention & control , Immunization Programs/methods , Palivizumab/administration & dosage , Health Plan Implementation/methods
12.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 38: e2018120, 2020. tab, graf
Article in English | LILACS | ID: biblio-1092147

ABSTRACT

ABSTRACT Objective: To evaluate the trend of hospitalization for acute bronchiolitis in infants under one year of age, in the past eight years and after the implementation of the palivizumab immunization program in Brazil. Methods: The study is a retrospective analysis of data on infants younger than one year of age, who were hospitalized with acute bronchiolitis between 2008 and 2015 in Brazil. The Brazilian National Health System database was used. The rates of hospitalization in the pre-implementation (2008-2012) and post-implementation (2014-2015) periods of the palivizumab immunization program were evaluated. The total number of admissions in the same period was used as a comparison. Results: Between January 2008 and December 2015, 263,679 hospitalizations for bronchiolitis were recorded in infants younger than one year of age, 60% represented by boys. The incidence of hospitalization for bronchiolitis increased by 49% over this period (8.5 to 12.7 per 1,000 inhabitants per year). Between 2013 and 2014, the incidence rate of hospitalization for acute bronchiolitis decreased by 8% (12.5 to 11.5 per 1,000 inhabitants per year). However, in the second year of the program, hospitalization rate increased again by 10% (12.7 per 1,000 inhabitants per years). Conclusions: Acute bronchiolitis presented increasing rates of hospitalization over the study period. Hospitalization incidence for acute bronchiolitis declined one year after the implementation of palivizumab but increased again in the second year of the program.


RESUMO Objetivo: Avaliar a tendência de hospitalização por bronquiolite aguda (BA) em lactentes menores de um ano de idade nos últimos oito anos no Brasil e, secundariamente, após a implementação do programa de imunização por palivizumabe. Métodos: Análise retrospectiva dos dados de lactentes menores de um ano de idade, hospitalizados com diagnóstico de BA entre 2008 e 2015 no Brasil, utilizando o banco de dados do Sistema Único de Saúde (SUS). Foram avaliadas as taxas de hospitalização nos períodos pré-implementação (2008-2012) e pós-implementação (2014-2015) do programa de imunização por palivizumabe. O número total de internações no mesmo período foi utilizado como comparação. Resultados: Entre janeiro de 2008 e dezembro 2015 foram registradas 263.679 internações por bronquiolite em lactentes menores de um ano de idade, 60% representado por meninos. A incidência de hospitalização por bronquiolite aumentou em 49% ao longo desse período (8,5 para 12,7 por mil ­habitantes/­ano). Entre 2013 e 2014, a taxa de incidência de hospitalização por BA diminuiu 8% (12,5 para 11,5 por mil habitantes/ano). Porém, no segundo ano do programa, a taxa de internação aumentou novamente em 10% (12,7 por mil habitantes/ano). Conclusões: A BA apresentou taxas de hospitalização crescente ao longo do período estudado. A incidência de hospitalizações de BA apresentou declínio um ano após a implementação de palivizumabe e retornou à tendência crescente no segundo ano do programa.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Antiviral Agents/therapeutic use , Bronchiolitis/drug therapy , Bronchiolitis/epidemiology , Palivizumab/therapeutic use , Hospitalization/trends , Antiviral Agents/administration & dosage , Respiratory Syncytial Viruses/immunology , Time Factors , Brazil/epidemiology , Bronchiolitis/immunology , Bronchiolitis/virology , Acute Disease , Incidence , Retrospective Studies , Respiratory Syncytial Virus Infections/prevention & control , Immunization Programs/methods , Palivizumab/administration & dosage , Health Plan Implementation/methods
13.
Ciênc. Saúde Colet. (Impr.) ; 25(9): 3413-3419, Mar. 2020.
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1133142

ABSTRACT

Abstract When Covid-19 emerged in December last year, there was no vaccine nor was there specific effective treatment for this fast-spreading and life-threatening viral respiratory infection. Clinical trials were planned and are in progress to investigate whether drugs used for influenza, HIV and other viruses, and also anthelmintics (ivermectin, nitazoxanide, niclosamide), and antimalarials (chloroquine, hydroxychloroquine) showing antiviral activity in in vitro assays, are effective and safe for Covid-19. So far there is no convincing evidence that these antiviral and antiparasitic drugs are of any benefit for Covid-19. Notwithsanding the absence of evidence of clinical efficacy, these drugs are widely used outside of clinical trials (off label) for prophylaxis and treatment of this viral infection. The rationale behind the prescription of macrolide antibiotics (azithromycin) for Covid-19 is obscure as well. The widespread prescription and use of drugs of unproven efficacy and safety for Covid-19 is at odds with the rational use of medicines, a cornerstone principle of pharmacotherapy advanced by WHO in 1985. This irrational use of drugs is cause for concern because some of them are associated with serious heart disorders and deaths.


Resumo Quando a Covid-19 surgiu em dezembro do ano passado, não havia vacina nem tratamento eficaz específico para esta infecção respiratória viral de rápida disseminação e risco de vida. Ensaios clínicos foram planejados e estão em andamento para investigar se os medicamentos usados para influenza, HIV e outros vírus e também anti-helmínticos (ivermectina, nitazoxanida, niclosamida) e antimaláricos (cloroquina, hidroxicloroquina) mostrando atividade antiviral em ensaios in vitro são eficazes e seguros para Covid-19. Até o momento, não há evidências convincentes de que esses medicamentos antivirais e antiparasitários sejam benéficos para a Covid-19. Não obstante a ausência de evidência de eficácia clínica, esses medicamentos são amplamente utilizados fora dos ensaios clínicos (off label) para profilaxia e tratamento dessa infecção viral. A lógica por trás da prescrição de antibióticos macrolídeos (azitromicina) para a Covid-19 também é obscura. A ampla prescrição e uso de medicamentos de eficácia e segurança não comprovadas para a Covid-19 está em desacordo com o uso racional de medicamentos, um princípio fundamental da farmacoterapia promovido pela OMS em 1985. Esse uso irracional de medicamentos é motivo de preocupação, porque alguns deles estão associados a graves doenças cardíacas e mortes.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Off-Label Use , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Pneumonia, Viral/virology , Practice Patterns, Physicians'/standards , Coronavirus Infections , Coronavirus Infections/virology , Inappropriate Prescribing/statistics & numerical data , Pandemics
14.
Ciênc. Saúde Colet. (Impr.) ; 25(9): 3517-3554, Mar. 2020. tab, graf
Article in Portuguese | LILACS, ColecionaSUS, SES-SP | ID: biblio-1133149

ABSTRACT

Resumo O objetivo deste trabalho foi avaliar efeitos de tratamentos medicamentosos para infecções por coronavírus. Revisão sistemática rápida com buscas nas bases MEDLINE, EMBASE, Cochrane, BVS, Global Index Medicus, Medrix, bioRxiv, Clinicaltrials.gov e International Clinical Trials Registry Platform. Foram incluídos 36 estudos avaliando alternativas medicamentosas contra SARS, SARS-CoV-2 e MERS. A maioria dos estudos incluídos foi conduzida na China com delineamento observacional para tratamento da COVID-19. Os tratamentos mais estudados foram antimaláricos e antivirais. Nos antimaláricos, a metanálise de dois estudos com 180 participantes não identificou benefício da hidroxicloroquina em relação à negativação da carga viral via reação em cadeia de polimerase em tempo real e o uso de antivirais comparado ao cuidado padrão foi similar em relação aos desfechos. As evidências científicas disponíveis são preliminares e de baixa qualidade metodológica, o que sugere cautela na interpretação dos dados. Pesquisas que avaliem a eficácia comparativa em ensaios clínicos randomizados, controlados, com tempo de acompanhamento adequado e com os métodos devidamente divulgados e sujeitos à revisão científica por pares são necessárias. Recomenda-se atualização periódica da presente revisão.


Abstract This work aimed to evaluate the effects of drug therapies for coronavirus infections. Rapid systematic review with search in the MEDLINE, EMBASE, Cochrane, BVS, Global Index Medicus, Medrix, bioRxiv, Clinicaltrials.gov and International Clinical Trials Registry Platform databases. Thirty-six studies evaluating alternative drugs against SARS, SARS-CoV-2 and MERS were included. Most of the included studies were conducted in China with an observational design for the treatment of COVID-19. The most studied treatments were with antimalarials and antivirals. In antimalarial, the meta-analysis of two studies with 180 participants did not identify the benefit of hydroxychloroquine concerning the negative viral load via real-time polymerase chain reaction, and the use of antivirals compared to standard care was similar regarding outcomes. The available scientific evidence is preliminary and of low methodological quality, which suggests caution when interpreting its results. Research that evaluates comparative efficacy in randomized, controlled clinical trials, with adequate follow-up time and with the methods properly disclosed and subject to scientific peer review is required. A periodic update of this review is recommended.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Severe Acute Respiratory Syndrome/drug therapy , Antiviral Agents/administration & dosage , Pneumonia, Viral/virology , Randomized Controlled Trials as Topic , Coronavirus Infections , Coronavirus Infections/virology , Severe Acute Respiratory Syndrome/virology , SARS Virus/isolation & purification , SARS Virus/drug effects , Pandemics , Middle East Respiratory Syndrome Coronavirus/isolation & purification , Middle East Respiratory Syndrome Coronavirus/drug effects , Betacoronavirus , Betacoronavirus/isolation & purification , Betacoronavirus/drug effects , Antimalarials/administration & dosage
15.
Rev. Soc. Bras. Med. Trop ; 53: e20190594, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136866

ABSTRACT

Abstract INTRODUCTION We conducted a cost-utility analysis of available interferon-free treatments for patients with early-stage genotype 1 chronic hepatitis C based on a Brazilian public health system perspective. METHODS A Markov model was derived using a cohort of stage F0-F2 patients treated as recommended by the Brazilian national guidelines. RESULTS: Glecaprevir plus pibrentasvir was superior to all other treatments, followed by sofosbuvir plus velpatasvir. Sofosbuvir plus daclatasvir was identified as the least cost-effective option. CONCLUSIONS: The above findings were confirmed via probabilistic sensitivity analysis and the tested scenarios.


Subject(s)
Humans , Antiviral Agents/economics , Hepacivirus/genetics , Hepatitis C, Chronic/economics , Hepatitis C, Chronic/drug therapy , Drug Therapy, Combination/economics , Antiviral Agents/administration & dosage , Cost-Benefit Analysis , Drug Therapy, Combination/methods , Genotype
16.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 38: e2018120, 2020. tab, graf
Article in English, Portuguese | LILACS, SES-SP | ID: biblio-1136733

ABSTRACT

ABSTRACT Objective: To evaluate the trend of hospitalization for acute bronchiolitis in infants under one year of age, in the past eight years and after the implementation of the palivizumab immunization program in Brazil. Methods: The study is a retrospective analysis of data on infants younger than one year of age, who were hospitalized with acute bronchiolitis between 2008 and 2015 in Brazil. The Brazilian National Health System database was used. The rates of hospitalization in the pre-implementation (2008-2012) and post-implementation (2014-2015) periods of the palivizumab immunization program were evaluated. The total number of admissions in the same period was used as a comparison. Results: Between January 2008 and December 2015, 263,679 hospitalizations for bronchiolitis were recorded in infants younger than one year of age, 60% represented by boys. The incidence of hospitalization for bronchiolitis increased by 49% over this period (8.5 to 12.7 per 1,000 inhabitants per year). Between 2013 and 2014, the incidence rate of hospitalization for acute bronchiolitis decreased by 8% (12.5 to 11.5 per 1,000 inhabitants per year). However, in the second year of the program, hospitalization rate increased again by 10% (12.7 per 1,000 inhabitants per years). Conclusions: Acute bronchiolitis presented increasing rates of hospitalization over the study period. Hospitalization incidence for acute bronchiolitis declined one year after the implementation of palivizumab but increased again in the second year of the program.


RESUMO Objetivo: Avaliar a tendência de hospitalização por bronquiolite aguda (BA) em lactentes menores de um ano de idade nos últimos oito anos no Brasil e, secundariamente, após a implementação do programa de imunização por palivizumabe. Métodos: Análise retrospectiva dos dados de lactentes menores de um ano de idade, hospitalizados com diagnóstico de BA entre 2008 e 2015 no Brasil, utilizando o banco de dados do Sistema Único de Saúde (SUS). Foram avaliadas as taxas de hospitalização nos períodos pré-implementação (2008-2012) e pós-implementação (2014-2015) do programa de imunização por palivizumabe. O número total de internações no mesmo período foi utilizado como comparação. Resultados: Entre janeiro de 2008 e dezembro 2015 foram registradas 263.679 internações por bronquiolite em lactentes menores de um ano de idade, 60% representado por meninos. A incidência de hospitalização por bronquiolite aumentou em 49% ao longo desse período (8,5 para 12,7 por mil ­habitantes/­ano). Entre 2013 e 2014, a taxa de incidência de hospitalização por BA diminuiu 8% (12,5 para 11,5 por mil habitantes/ano). Porém, no segundo ano do programa, a taxa de internação aumentou novamente em 10% (12,7 por mil habitantes/ano). Conclusões: A BA apresentou taxas de hospitalização crescente ao longo do período estudado. A incidência de hospitalizações de BA apresentou declínio um ano após a implementação de palivizumabe e retornou à tendência crescente no segundo ano do programa.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Antiviral Agents/therapeutic use , Bronchiolitis/drug therapy , Bronchiolitis/epidemiology , Palivizumab/therapeutic use , Hospitalization/trends , Antiviral Agents/administration & dosage , Respiratory Syncytial Viruses/immunology , Time Factors , Brazil/epidemiology , Bronchiolitis/immunology , Bronchiolitis/virology , Acute Disease , Incidence , Retrospective Studies , Respiratory Syncytial Virus Infections/prevention & control , Immunization Programs/methods , Palivizumab/administration & dosage , Health Plan Implementation/methods
17.
Arq. gastroenterol ; 56(4): 394-398, Oct.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1055164

ABSTRACT

ABSTRACT BACKGROUND: In recent years the management of hepatitis C virus infection and the possibility of its eradication have been researched due to the importance that they represent in the health of the world population. Obtaining data that help to cope with this pathology improves the quality of life of those affected by it. The present study evaluated the effectiveness of direct-acting antiviral therapies provided by the Brazilian Ministry of Health in accordance to the Clinical Protocol and Therapeutic Guidelines of 2015. OBJECTIVE: To evaluate the epidemiological profile of patients with chronic hepatitis C and the rate of sustained virologic response using direct-acting antivirals of all individuals that attended the referral service for the treatment of chronic hepatitis C at the Hospital of the Federal University of Rio Grande. METHODS: This was an observational, retrospective/prospective study with all patients with chronic hepatitis C who had their treatments available from December 2015 to August 2017 according to the criteria of the Clinical Protocol and Therapeutic Guidelines of 2015. In the first phase, the clinical and demographic variables of all individuals enrolled in a treatment for hepatitis C were selected and collected from the Reference Service database. In the second phase, treatment data were collected. The outcome variable, sustained virologic response, was defined as an undetectable viral load on the blood test three months after the end of treatment. The descriptive and bivariate analyzes were performed with Pearson's chi-square and Fisher's Exact test, adopting a P value ≤0.05 in the SPSS 20 software. RESULTS: Of the 252 participants in the study, 228 (90.5%) had a sustained virologic response, 55.2% were male with an average age of 58.6 years (SD±9.1). Genotype 1 was the most prevalent, observed in 54.4% of the participants, and 87.4% of the patients had moderate/advanced hepatic fibrosis. After the statistical analysis, it was observed that the individuals with genotype 3 and moderate/advanced hepatic fibrosis had lower sustained virologic response rate (P=0.05 and P=0.04, respectively). CONCLUSION: It was observed that the use of direct-acting antivirals, in comparison to previous therapeutic regimens, increases the sustained virologic response, reaching all patients with mild fibrosis. This study provides information that helps in the hepatitis C treatment by showing that prescribing early treatment for patients without hepatic fibrosis and/or genotype 3 virus could increase therapeutic effectiveness.


RESUMO CONTEXTO: O manejo e a possibilidade de erradicação da infecção pelo vírus da hepatite C têm sido muito pesquisados nos últimos anos pela importância que representam na saúde pública para a população mundial. A obtenção de dados que auxiliem o enfrentamento dessa patologia resulta na melhor qualidade de vida dos seus portadores. O presente estudo avaliou a efetividade da terapêutica com os antivirais de ação direta, fornecida pelo Ministério da Saúde, através do Protocolo Clínico e Diretrizes Terapêuticas de 2015. OBJETIVO: Avaliar o perfil epidemiológico dos portadores de hepatite C crônica e a taxa de resposta viral sustentada com o uso dos antivirais de ação direta em todos os indivíduos atendidos no Centro de Referência no tratamento da hepatite C crônica do Hospital Universitário da Universidade Federal do Rio Grande. MÉTODOS: Estudo observacional retrospectivo/prospectivo com todos os portadores de hepatite C crônica que tiveram seus tratamentos disponibilizados no período de dezembro de 2015 a agosto de 2017 segundo os critérios do Protocolo Clínico e Diretrizes Terapêuticas de 2015. Na primeira fase foram selecionadas e coletadas as variáveis demográficas e clínicas, no banco de dados do centro de referência de todos os indivíduos cadastrados para tratamento para hepatite C e na segunda fase foram coletados dados referentes ao tratamento. A variável desfecho, resposta viral sustentada, foi definida pela carga viral indetectável no exame sanguíneo três meses após o término do tratamento. Foram realizadas as análises descritivas e bivariadas com cálculo do qui quadrado de Pearson e Exato de Fisher, adotando um valor P≤0,05, no programa SPSS 20. RESULTADOS: Dos 252 participantes do estudo 228 (90,5%) obtiveram resposta viral sustentada, sendo 55,2% do sexo masculino com média de idade de 58,6 anos (DP±9,1). O genótipo 1 foi o mais prevalente, presente em 54,4% dos participantes, 87,4% dos estudados apresentavam grau de fibrose hepática moderada/avançada. Após a análise estatística observou-se que os indivíduos com genótipo 3 e fibrose hepática moderada/avançada, tiveram menor taxa de resposta viral sustentada (P=0,05 e P=0,04 respectivamente). CONCLUSÃO: Observou-se que com o uso dos antivirais de ação direta as taxas de resposta viral sustentada foram altas, em relação aos esquemas terapêuticos anteriores, podendo chegar à totalidade nos pacientes com fibrose leve. Este estudo mostra que a realização do tratamento precoce, ou seja, de forma antecipada em pacientes sem fibrose hepática e genótipo 3 pode aumentar a taxa de sucesso.


Subject(s)
Humans , Male , Female , Aged , Antiviral Agents/administration & dosage , Hepatitis C, Chronic/drug therapy , Sustained Virologic Response , Quality of Life , Prospective Studies , Retrospective Studies , Treatment Outcome , Viral Load , Drug Therapy, Combination , Middle Aged
18.
Gac. méd. Méx ; 155(1): 80-89, Jan.-Feb. 2019. tab
Article in English, Spanish | LILACS | ID: biblio-1286463

ABSTRACT

Resumen La infección por el virus de hepatitis C es un problema global de salud pública; en México aproximadamente 2 % de la población se encuentra infectada. En niños, los datos de prevalencia son variables según la edad, pero se estima que 0.1 a 2 % de los niños presenta infección crónica por virus de hepatitis C, cuya principal vía de transmisión es la perinatal. Actualmente existen antivirales de acción directa aprobados en adultos con una tasa de respuesta viral sostenida superior a 95 %; sin embargo, en niños aún son pocos los estudios que confirman su seguridad y efectividad. Aunque todavía estamos lejos de la meta, avanzamos rápidamente hacia un tratamiento óptimo de curación también para pacientes pediátricos.


Abstract Infection with hepatitis C virus is a global health problem; in Mexico, approximately 2% of the population is infected. In children, data on prevalence are variable according to the age group, but 0.1-2% of children are estimated to have chronic infection with hepatitis C virus, the main way of transmission of which is perinatal. Currently, there are direct-acting antiviral agents approved in adults that offer a sustained viral response rate higher than 95%; however, in children there are still only few studies confirming their safety and effectiveness. Although we are still far from the goal, we are rapidly advancing towards an optimal curative treatment also for pediatric patients.


Subject(s)
Humans , Female , Pregnancy , Child , Antiviral Agents/administration & dosage , Hepatitis C, Chronic/epidemiology , Antiviral Agents/adverse effects , Pregnancy Complications, Infectious/virology , Prevalence , Age Factors , Infectious Disease Transmission, Vertical/statistics & numerical data , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/transmission , Mexico/epidemiology
19.
Rev. gastroenterol. Perú ; 39(1): 45-54, ene.-mar. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1014125

ABSTRACT

Objetivos: La terapia ideal para la hepatitis crónica C consiste en el uso de drogas antivirales de acción directa (DAA). En el Perú la experiencia en vida real con DAA no se conoce, por lo que el objetivo del presente estudio es reportar la alta eficacia terapéutica con estos esquemas. Material y métodos: Mediante correo electrónico se invitó a participar a través de una encuesta a médicos hepatólogos a nivel nacional. Se incluyeron los datos de 4 médicos. Los resultados fueron analizados con estadística descriptiva. Resultados: Se incluyeron 63 pacientes, la edad promedio fue 59 años, varones fueron 49,21%, cirrosis estuvo presente en el 49,21% (31/63), 34,92% había sido no respondedor a terapia con PEGIFN/RBV. El Genotipo 1 estuvo presente en 93,65% de casos, siendo el 1a el predominante (58,73%). Solo hubo dos casos de genotipo 2 y uno de genotipo 3. Se utilizaron 10 esquemas de combinación con DAA, siendo los más eficaces, Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/ Ribavirina y Sofosbuvir/Simeprevir, en todos ellos se logró Respuesta Viral Sostenida (RVS) de 100%. Con los otros 7 esquemas la RVS fue menor a 90% o solo se había incluido uno o dos pacientes. La tolerancia a la terapia fue adecuada y todos los pacientes culminaron la terapia. Conclusiones: En vida real los esquemas de terapia antiviral para hepatitis C con DAA tienen alta eficacia y seguridad. Las mejores respuestas se obtuvieron con Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina y Sofosbuvir/Simeprevir. Esta data puede ser útil para considerar estrategias de tratamiento con el enfoque de salud pública.


Objective: The ideal therapy for chronic hepatitis C is the use of direct acting antivirals (DAA). In Peru there is no data in this aspect, in that sense it is necessary to report real life experience with these drugs. Material and methods: A digital survey was sent through e-mail to hepatologists, and the data of four is considered in this study. Statistical analysis was descriptive. Results: We included 63 patients, mean age was 59 years, 49.21% were male, cirrhosis was present in 49.21%, and 34.92% was non-responder to PEGIFN and Ribavirin. Genotype 1 was present in 93.65%, and subtype 1a was 58.73%, there were only 2 cases with Gt 2 and one with Gt 3. There were 10 different DAA combinations used, and the most effective were Sofosbuvir/ Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir, in all these cases the Sustained Viral Response (SVR) was 100%. The other combinations had SVR < 90% or only 1-2 patients included. All patients tolerated treatments and no serious adverse events occurred. Conclusions: In real life antiviral treatment for hepatitis C with AAD is effective and well tolerated. The best SVR was obtained with Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir. This report may be useful to consider treatment strategies with focus in public health.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Antiviral Agents/administration & dosage , Peru , Treatment Outcome , Hepacivirus/drug effects , Hepacivirus/genetics , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/virology , Drug Evaluation , Drug Therapy, Combination , Genotype , Liver Cirrhosis/etiology , Liver Cirrhosis/pathology
20.
Braz. j. med. biol. res ; 52(8): e8519, 2019. tab
Article in English | LILACS | ID: biblio-1011607

ABSTRACT

Recurrent hepatitis C (HCV) after liver transplantation (LT) is an important cause of morbidity and mortality. Antiviral treatment is recommended to avoid unfavorable outcomes. Direct-acting antivirals (DAA) have transformed HCV treatment, with higher efficacy and fewer side-effects than interferon-based therapies traditionally used. To evaluate DAA treatment outcomes at a Brazilian transplant unit, data of patients who finished HCV treatment at the Liver Transplant Unit of the University of Campinas were analyzed. Treatment consisted of sofosbuvir, daclatasvir, and ribavirin, for 12 or 24 weeks, according to the national guidelines. Fifty-five patients completed antiviral treatment and 54 had HCV-viral load results available. The majority of patients were male (78%), 58 years old on average, 65% had hepatocellular carcinoma (HCC) before LT, and 67% were interferon treatment-experienced. Most patients had HCV genotype 1 (65%), 35% had genotype 3, and started treatment on an average of 38 months after LT (range: 2-228). Fifty-eight percent were treated for 12 weeks and 42% for 24 weeks, using a mean dose of ribavirin of 10.1 mg/kg (4.2-16.1). There were no treatment interruptions due to serious side effects. The sustained virological response rate was 98%. Only one patient relapsed, a genotype 3 cirrhotic treated for 12 weeks. The average follow-up after starting antivirals was 20 months. There were no recurrences of HCC, but there was one rejection episode and one cirrhosis decompensation episode, both 12 weeks after treatment. DAA treatment is safe and effective in the post-LT setting and was not associated to HCC recurrence in the cohort studied.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Antiviral Agents/administration & dosage , Ribavirin/administration & dosage , Liver Transplantation/adverse effects , Hepatitis C/drug therapy , Sofosbuvir/administration & dosage , Imidazoles/administration & dosage , Recurrence , Retrospective Studies , Treatment Outcome , Viral Load , Drug Therapy, Combination , Sustained Virologic Response , Genotype
SELECTION OF CITATIONS
SEARCH DETAIL