Antivirales de acción directa: la nueva era del tratamiento de la hepatitis C. Desde el interferón hasta la eliminación.
Hepatitis C virus (HCV) is a RNA virus, parenteral transmitted that, after an acute infection, becomes chronic in 75% of the cases. Chronic infection presents risk of cirrhosis progression and cirrhosis complications such as ascites, encephalopathy, variceal bleeding or hepatocellular carcinoma. Hep...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Universidad de Valladolid |
| Repositorio: | UVaDOC. Repositorio Documental de la Universidad de Valladolid |
| OAI Identifier: | oai:uvadoc.uva.es:10324/59937 |
| Acceso en línea: | https://doi.org/10.35376/10324/59937 https://uvadoc.uva.es/handle/10324/59937 |
| Access Level: | acceso abierto |
| Palabra clave: | Virology Infectious Diseases Hepatitis C Treatment Tratamiento Antivirals Antivirales 3205.05 Enfermedades Infecciosas |
| Sumario: | Hepatitis C virus (HCV) is a RNA virus, parenteral transmitted that, after an acute infection, becomes chronic in 75% of the cases. Chronic infection presents risk of cirrhosis progression and cirrhosis complications such as ascites, encephalopathy, variceal bleeding or hepatocellular carcinoma. Hepatitis C treatment has evolved in the last years. In 1984, patients were treated with interferon (INF), a subcutaneous administrated drug with high number of adverse events and low rates of sustained virological response (SVR). Some years later, this treatment was modified to pegilated-INF and ribavirin (RBV), that partially improve SVR but with similar adverse events. The hepatitis C treatment revolution happened in 2011 with the introduction of the first direct-acting antiviral (DAA), oral administrated, firstly prescribed together with INF and RBV (triple therapy). Although SVR rates were higher, adverse events were still important. Subsequently, DAA were used in therapies free of INF and later, also free of RBV, with high rates of SVR and with barely adverse events. Furthermore, the management of patients was also changing during those years. Thanks to the introduction of non-invasive methods to estimate liver fibrosis before treatment, liver biopsy became unnecessary. For all the previously mentioned, we came up with 4 hypothesis that are the aims of each article that are included in this thesis: - To evaluate the impact of triple therapy on liver fibrosis measured by transient elastography after SVR. - To investigated the real-world effectiveness and safety of INF-free treatments. - To analyse laboratory parameters, clinical and fibrosis long-term evolution in patients with advanced fibrosis cured with DAA. - To evaluate the results of a hepatitis C screening program in hospitalized COVID-19 patients. The conclusions of the aforementioned articles are: - SVR achieved with triple therapy produce a fast and significant reduction of the transient elastpgraphy values. - DAA in INF-free therapies administrated in a real-world setting present a high SVR with a low rate of adverse events. - In patients with advanced fibrosis or cirrhosis exist a rapid and long-lasting improvement of laboratory parameters and also and improvement of the liver fibrosis measured by non-invasive methods, but the risk of decompensation and apparition of hepatocellular carcinoma is not eliminate, so long-term monitoring is need. - Finally, HCV screening in hospitalized COVID-19 patients prove a lower prevalence of active hepatitis C than the expected, so nowadays, general screening in patients without risk factors is not justified. |
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