RESUMO
AIM: The development of direct-acting oral agents has dramatically changed the treatment strategy of hepatitis C virus (HCV) infection. Here we aimed to reveal the efficacy and safety of daclatasvir (DCV) and asunaprevir (ASV) for recurrent HCV genotype 1 infection after liver transplantation (LT). METHODS: A retrospective study was undertaken on nine patients who underwent a 24-week DCV/ASV treatment regimen for recurrent HCV genotype 1 infection. Five of the patients were men; four had failed treatment with pegylated interferon (Peg-IFN)/ribavirin, two had failed simeprevir/Peg-IFN/ribavirin, one had the resistance-associated variant Y93H in the NS5A region, and one underwent maintenance dialysis. RESULTS: Median time to treatment initiation following LT was 70 months. Of the nine patients treated with DCV/ASV, eight (88.9%) achieved a sustained viral response 12 weeks after completion of therapy (SVR12). The patient with virologic failure had failed simeprevir/Peg-interferon/ribavirin therapy 4 months before undergoing the DCV/ASV treatment regimen. In addition, a resistance-associated variant D168E in the NS3 region was detected in the patient after discontinuation of the DCV/ASV regimen. The trough level of tacrolimus tended to decrease, and renal function showed no significant changes during treatment. Adverse events occurred in two patients (22.2%), but no severe adverse events occurred during treatment. CONCLUSIONS: The DCV/ASV regimen was well tolerated, resulting in high rates of sustained viral response 12 weeks after completion of therapy for LT patients with recurrent HCV genotype 1 infection.
RESUMO
We determined effect of aerobic exercise in early evening on the quality, quantity, and haemodynamic response of subsequent nocturnal sleep in the home. Ten healthy young participants performed two protocols, with/without cycle ergometer exercise (60 min at 50% heart rate reserve) in early evening. Blood pressure (BP) (Holter) and physical activity (accelerometer) were measured from late afternoon of day 1 until noon of next day (day 2). Additionally, at bedtime participants were equipped with a small device worn on the wrist that identified sleep stage. There were no substantial differences in objective indices of sleep between two protocols (total sleep time: 438 ± 76 vs. 457 ± 64 min; P > 0.10). BP during nocturnal sleep tended to be lowered by prior exercise (MAP: 71 ± 5 vs. 68 ± 6 mmHg; P = 0.08). Aerobic exercise in early evening apparently has no acute effect on sleep per se, but seems to have a residual effect on haemodynamics, i.e. prolongation of post-exercise hypotension.