Résumé
Chronic hepatitis C virus (HCV) infection is now the most important cause of liver cirrhosis and hepatocellular carcinoma worldwide. HCV infection prevalence is high among haemophiliacs (39 percent-98 percent), who got infected when received inadequately or non-virus-inactivated large-pool clotting factors concentrates before 1992. Current treatment reduces the probability of developing advanced stages of liver disease. The objective of this study was to evaluate efficacy and safety of the treatment with interferon alpha (IFN) and ribavirin in haemophiliacs. From July 2000 to November 2002, 18 patients were treated with IFN, three million units thrice weekly combined with daily oral doses of 1,000 or 1,250 mg of ribavirin for a minimum of 48 weeks. Eleven patients (61 percent) showed end of treatment virological response, while nine [(50 percent): 95 percent CI: 27-73 percent] showed sustained virological response as defined by undetectable HCV-RNA six months after treatment. All those nine had persistently undetectable HCV-RNA two to four years post-treatment. There was no treatment interruption due to adverse events. Therefore, the rate of sustained virological response was 50 percent, with good tolerance.
Sujets)
Adolescent , Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Antiviraux/usage thérapeutique , Hémophilie A/complications , Hépatite C chronique/traitement médicamenteux , Interféron alpha/usage thérapeutique , Ribavirine/usage thérapeutique , Antiviraux/administration et posologie , Association de médicaments , Génotype , Hepacivirus/génétique , Interféron alpha/administration et posologie , ARN viral/analyse , Ribavirine/administration et posologie , Résultat thérapeutique , Jeune adulteRésumé
A susceptibilidade à infecçäo aumenta dramaticamente quando a contagem periférica de neutrófilos cai abaixo de 500cels/mm3, e particularmente quando abaixo de 100cls/mm3. A rapidez da queda dos granulócitos e a duraçäo da aplasia estäo mais associados com os quadros infecciosos. Culturas de vigilância têm mostrado um valor limitado em predizer uma infecçäo invasiva em pacientes neutropênicos ou com câncer. O isolamento protetor simples em pacientes com granulocitopenia parece näo beneficiar a profilaxia das doenças infecciosas. O uso de descontaminaçäo digestiva seletiva, reduziu infecçöes do trato respiratório e septcemias bacterianas em crianças. O objetivo deste procedimento é eliminar microorganismos patogênicos potenciais, como Enterobacteriaceae, P. aeruginosa e Staphilococci. Os estudos mais recentes têm discutido o uso de Fator estimulador de colonias (CSF) associado a interferon-gama para prevençäo de infecçöes nesses pacientes