ABSTRACT
Objetivo: Evaluar la respuesta virológica sostenida (RVS) y los factores predictores de la misma en los pacientes con infección crónica por el virus de la hepatitis C (VHC) tratados con peginterferón alfa-2a y ribavirina. Pacientes: Estudio retrospectivo de 272 pacientes naïve con infección crónica por el VHC tratados durante 24 ó 48 semanas y con seguimiento durante 24 semanas después de retirar el tratamiento. Resultados: De los 272 pacientes, 243 completaron el tratamiento. La RVS en el análisis por intención de tratar fue del 66,5%, y en pacientes tratados 74,5%. En el análisis univariado, la RVS fue mayor en menores de 40 años (84,4%), con carga viral pretratamiento <500.000 UI/ml (86,9%), genotipo no-1 (86,4%), no cirróticos ni precirróticos (76,5%), con respuesta virológica rápida (RVR) (91,4%) y con respuesta virológica precoz (RVP) (83,8%) (p<0.01). El análisis multivariado mostró que solo el genotipo y la RVP influyeron en la RVS. La RVR y el grado de lesión hepática no se incluyeron en el análisis multivariado porque no se dispuso de estas variables en un alto número de pacientes. Los VPP y VPN de la RVR fueron 91,5% y 48,7% respectivamente, de la RVP 83,8% y 95,8% y de la RVP completa 91,3% y 78,7% respectivamente. Conclusiones: La RVS en nuestra serie fue mayor que en otros estudios. Los factores predictores de RVS fueron el genotipo y la RVP. La RVP presentó un alto VPN y la RVP completa un alto VPP(AU)
Objective: The aim of this study was evaluate the rate of sustained viral response (SVR) and the influence of different factors on the SVR in patients with chronic hepatitis C virus (HCV) infection treated with pegylated interferon alfa 2a and ribavirin. Methods: We retrospectively analysed 272 naïve patients with chronic hepatitis C who had been treated for 24 weeks or 48 weeks and had been followed for an additional 6 months thereafter. Results: Out of 272 patients, 243 completed the entire treatment. The overall SVR rate in intent-to-treat analysis was 66.5% and in treated patients was 74.5%. In an univariate analysis, the SVR was associated with age <40 years (84.4%), pre-treatment viral load <500.000 IU/ml (86.9%), non-1 genotype HCV (86.4%), non cirrhosis or pre-cirrhosis (76.5%), rapid virologic response (RVR) (91.4%) and early virologic response (EVR) (83.8%). In the multivariate logistic regression analysis, the presence of an infection caused by a non-1 genotype and to achieve ERV were independent predictors of SVR. The RVR and histological stage of liver disease were not included in the multivariate analysis because these data were not available in most of the patients. The PPV and NVP of RVR were 91.5% and 48.7% respectively, of EVR were 83.8% and 95.8% respectively and of complete EVR were 91.3% and 78.7%, respectively. Conclusions: The SVR was higher than in other studies. The genotype and EVR were independent factors to predict the effect of antiviral therapy. The EVR had a high NPV and the complete EVR a high PPV(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Infections/complications , Infections/drug therapy , Hepatitis C/complications , Hepatitis C/drug therapy , Ribavirin/therapeutic use , Interferons/therapeutic use , Dose-Response Relationship, Drug , Response Elements , Retrospective StudiesABSTRACT
Introducción El conocimiento de la infección aguda por el virus de la hepatitis C (VHC) es importante para diseñar estrategias de prevención y tratamiento efectivas. El objetivo del estudio fue conocer las características clinicoepidemiológicas y la evolución de los pacientes diagnosticados de infección aguda por VHC.MétodosEstudio clinicoepidemiológico descriptivo retrospectivo de los pacientes adultos con infección aguda por VHC diagnosticados entre los años 2000-2008 en nuestro hospital.ResultadosSe diagnosticó a 16 pacientes. La fuente probable de transmisión fue la adicción a drogas por vía parenteral (ADVP) en 4 casos, un accidente sanitario por pinchazo en 3 casos, un procedimiento médico en 3 casos y la vía sexual en 2 casos. En 4 casos la fuente de infección fue desconocida. Ocho pacientes se diagnosticaron por un cuadro clínico sintomático, (3 en los controles por accidente sanitario y en 5 la detección fue casual). Nueve pacientes presentaron síntomas francos y 7 fueron asintomáticos o tuvieron síntomas leves. Los 4 pacientes que recibieron tratamiento se curaron y de los 12 pacientes que no recibieron tratamiento, el 58,3% cronificó. Se observó una mayor tendencia a la cronificación en los pacientes que no presentaron ictericia frente a los que la presentaron (el 85,7 vs. el 16,7%).ConclusionesLos procedimientos médicos siguen siendo un factor de riesgo de adquisición de la infección por el VHC, por lo que es necesaria la búsqueda activa así como insistir en el cumplimiento de las medidas de prevención de transmisión parenteral. Debido al bajo porcentaje de pacientes con ictericia que cronifican, el inicio del tratamiento en estos pacientes podría retrasarse en función de su evolución (AU)
Introduction Knowledge of acute hepatitis C infection (AHC) is important to design effective prevention and treatment strategies. The aim of this study was to determine the clinical and epidemiological features and outcomes of patients diagnosed with AHC.MethodsA retrospective clinical-epidemiological study was carried out in adult patients diagnosed with AHC between 2000 and 2008 in our hospital.ResultsSixteen patients were diagnosed. The most probable source of transmission was intravenous drug abuse in four patients, a percutaneous injury in three healthcare workers, a medical procedure in three patients and sexual contact in two patients. The source of infection was unknown in four patients. Diagnosis was based on acute clinical symptoms in eight patients, follow-up of healthcare injury in three patients and was fortuitous in five patients. Nine patients showed severe symptoms, while seven patients were asymptomatic or had mild symptoms. The four patients who received treatment were cured. Of the 12 patients that did not receive treatment, the disease became chronic in 58.3%. Progression to chronic disease was more frequent in patients without jaundice than in those with jaundice (85.7% vs 16.7%).ConclusionsBecause medical procedures are still a risk factor for hepatitis C infection, active surveillance is required as well as compliance with prevention measures against parenteral transmission. The percentage of patients with jaundice who progress to chronic disease is low and consequently the start of treatment in these patients could be delayed according to their clinical course (AU)
Subject(s)
Humans , Male , Female , Adult , Hepatitis C/epidemiology , Hepacivirus/pathogenicity , Hepatitis C/transmission , Risk Factors , Jaundice/epidemiology , Antiviral Agents/therapeutic useABSTRACT
INTRODUCTION: Knowledge of acute hepatitis C infection (AHC) is important to design effective prevention and treatment strategies. The aim of this study was to determine the clinical and epidemiological features and outcomes of patients diagnosed with AHC. METHODS: A retrospective clinical-epidemiological study was carried out in adult patients diagnosed with AHC between 2000 and 2008 in our hospital. RESULTS: Sixteen patients were diagnosed. The most probable source of transmission was intravenous drug abuse in four patients, a percutaneous injury in three healthcare workers, a medical procedure in three patients and sexual contact in two patients. The source of infection was unknown in four patients. Diagnosis was based on acute clinical symptoms in eight patients, follow-up of healthcare injury in three patients and was fortuitous in five patients. Nine patients showed severe symptoms, while seven patients were asymptomatic or had mild symptoms. The four patients who received treatment were cured. Of the 12 patients that did not receive treatment, the disease became chronic in 58.3%. Progression to chronic disease was more frequent in patients without jaundice than in those with jaundice (85.7% vs 16.7%). CONCLUSIONS: Because medical procedures are still a risk factor for hepatitis C infection, active surveillance is required as well as compliance with prevention measures against parenteral transmission. The percentage of patients with jaundice who progress to chronic disease is low and consequently the start of treatment in these patients could be delayed according to their clinical course.
