ABSTRACT
Acute-on chronic liver failure (ACLF) has been an intensively debated topic mainly due to the lack of a unified definition and diagnostic criteria. The growing number of publications describing the mechanisms of ACLF development, the progression of the disease, outcomes and treatment has contributed to a better understanding of the disease, however, it has also sparked the debate about this condition. As an attempt to provide medical professionals with a more uniform definition that could be applied to our population, the first Mexican consensus was performed by a panel of experts in the area of hepatology in Mexico. We used the most relevant and impactful publications along with the clinical and research experience of the consensus participants. The consensus was led by 4 coordinators who provided the most relevant bibliography by doing an exhaustive search on the topic. The entire bibliography was made available to the members of the consensus for consultation at any time during the process and six working groups were formed to develop the following sections: 1.- Generalities, definitions, and criteria, 2.- Pathophysiology of cirrhosis, 3.- Genetics in ACLF, 4.- Clinical manifestations, 5.- Liver transplantation in ACLF, 6.- Other treatments.
ABSTRACT
Background: Patients with chronic kidney disease (CKD) have a higher prevalence of hepatitis C virus (HCV) infection compared to the general population, and they also present higher morbidity and mortality if they are not treated. Current treatment is based on different direct-acting antiviral (DAA) schemes, which are available in the Mexican health system. However, the efficacy and safety of DAA treatment in patients with CKD on hemodialysis and HCV infection are unknown in Mexican population. Objective: To determine the efficacy through sustained viral response (SVR) and the safety of DAAs in patients with CKD on hemodialysis and chronic HCV infection in the Mexican population. Material and methods: Real-life cohort study. Patients with CKD on hemodialysis and HCV infection treated with DAAs from a third level hospital were included. Descriptive statistics of the clinical characteristics were performed, efficacy was determined by SVR and safety with the global frequency of adverse effects associated with treatment. Results: 25 patients were included. All of them received treatment with glecaprebir/pibrentasvir for 8 weeks. The mean age was 57.8 years and the median time of CKD on hemodialysis was 5 years. 96% of patients had HCV genotype 1B. 100% of the patients presented SVR and the most frequent adverse effects were headache, nausea and fatigue. Conclusions: In the Mexican population studied, patients with HCV and CKD on hemodialysis presented a sustained viral response of 100% with glecaprevir/pibrentasvir with mild adverse effects.
Introducción: los pacientes con enfermedad renal crónica (ERC) tienen una mayor prevalencia de infección por virus de hepatitis C (VHC) en comparación con la población general y presentan mayor morbimortalidad si no se tratan. El tratamiento actual se basa en diferentes esquemas de antivirales de acción directa (ADD), disponibles en el sistema de salud mexicano; sin embargo, se desconoce su eficacia y seguridad en pacientes con ERC en hemodiálisis e infección por VHC en población mexicana. Objetivo: determinar la eficacia mediante respuesta viral sostenida (RVS) y la seguridad de los AAD en pacientes con ERC en hemodiálisis e infección crónica por VHC en población mexicana. Material y métodos: estudio de cohorte de vida real. Se incluyeron pacientes con ERC en hemodiálisis e infección por VHC tratados con AAD en un hospital de tercer nivel. Se usó estadística descriptiva de las características clínicas, se determinó eficacia mediante RVS y seguridad con la frecuencia global de efectos adversos asociados al tratamiento. Resultados: se incluyeron 25 pacientes. Todos recibieron tratamiento con glecaprebir/pibrentasvir durante ocho semanas. La media de edad fue 57.8 años y la mediana de tiempo de ERC en hemodiálisis fue de 5 años. El 96% de los pacientes presentó genotipo 1B de VHC. El 100% de los pacientes presentaron RVS y los efectos adversos más frecuentes fueron cefalea, náuseas y fatiga. Conclusiones: en la población mexicana estudiada, los pacientes con VHC y ERC en hemodiálisis presentaron respuesta viral sostenida del 100% con glecaprevir/pibrentasvir con efectos adversos leves.
