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Gastroenterol Hepatol ; 37 Suppl 1: 23-36, 2014 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-25907435

RESUMO

The treatment plan for chronic hepatitis C in special populations varies according to comorbidity and the current evidence on treatment. In patients with hepatitis C virus and HIV coinfection, the results of dual therapy (pegylated interferon plus ribavirin) are poor. In patients with genotype 1 infection, triple therapy (dual therapy plus boceprevir or telaprevir) has doubled the response rate, but protease inhibitors can interact with some antiretroviral drugs and provoke more adverse effects. These disadvantages are avoided by the new, second-generation, direct-acting antiviral agents. In patients who are candidates for liver transplantation or are already liver transplant recipients, the optimal therapeutic option at present is to combine the new antiviral agents, with or without ribavirin and without interferon. The treatment of patients under hemodialysis due to chronic renal disease continues to be dual therapy (often with reduced doses of pegylated interferon and ribavirin), since there is still insufficient information on triple therapy and the new antiviral agents. In mixed cryoglobulinemia, despite the scarcity of experience, triple therapy seems to be superior to dual therapy and may be used as rescue therapy in non-responders to dual therapy. However, a decision must always be made on whether antiviral treatment should be used concomitantly or after immunosuppressive therapy.


Assuntos
Hepatite C Crônica/tratamento farmacológico , Fármacos Anti-HIV/farmacocinética , Fármacos Anti-HIV/uso terapêutico , Antivirais/efeitos adversos , Antivirais/farmacocinética , Antivirais/uso terapêutico , Ensaios Clínicos como Assunto , Comorbidade , Crioglobulinemia/tratamento farmacológico , Crioglobulinemia/etiologia , Gerenciamento Clínico , Esquema de Medicação , Interações Medicamentosas , Quimioterapia Combinada , Previsões , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/cirurgia , Humanos , Imunossupressores/farmacocinética , Imunossupressores/uso terapêutico , Transplante de Rim , Transplante de Fígado , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Inibidores de Proteases/efeitos adversos , Inibidores de Proteases/farmacocinética , Inibidores de Proteases/uso terapêutico , Diálise Renal , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia
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