Noi tendinţe în tratamentul infecţiei cu

virusul hepatitei C -
http://baylor.ro/noutati/noi-tendinte-in-
tratamentul-infectiei-cu-virusul-
hepatitei-c
Cele mai recente studii arată o schimbare majoră în terapia hepatitei C. Protocoalele prevedeau ca
tratamentul să fie administrat atunci când cazurile deveneau grave, nu din stadiile incipiente.
Recomandarea venea ca urmare a faptului că accesul la medicamente era foarte redus, din cauza
preţului acestora.

Statisticile sunt îngrijorătoare. În raportul anual publicat în martie 2016, Societatea Americană de
Cancer a semnalat faptul că rata noilor cazuri de cancer de ficat creşte îngrijorător, ca şi rata deceselor
cauzate de cancerul de ficat. Între 2003 şi 2012, rata noilor cazuri de cancer de ficat a crescut cu 3,4%
la bărbaţi şi cu 2,4% la femei. În aceeaşi perioadă, decesele înregistrate printre bolnavii de cancer de
ficat au crescut cu 2.8% la bărbaţi şi cu 2.2% la femei. Hepatita C şi cancerul de ficat asociat acestei
boli au fost înregistrate mai frecvent la persoanele născute între 1945 şi 1965.

Studiile specialiştilor americani au arătat faptul că, dacă există posibilitatea, este bine să tratezi
persoanele care au un grad mai mic de fibroză hepatică, chiar dacă vorbim despre stadiul 1 sau 2,
pentru că aceste persoane au un risc mai mare de a dezvolta cancer în viitor.

Societatea Americană pentru Studiul Bolilor de Ficat arată că, din punct de vedere medical, datele
evidenţiază numeroasele beneficii ale tratamentului în stadii incipiente, care poate duce chiar la
eradicarea infecţiilor cu Virusul Hepatitic C (VHC). De asemenea, se recomandă tratamentul tuturor
pacienţilor cu infecţie cronică VHC, în afara celor cu speranţă mică de viaţă, care nu pot fi salvaţi prin
tratarea infecţiei cu VHC prin transplant sau prin altă terapie directă. În consecinţă, specialiştii
americani consideră că nu mai este necesară administrarea tratamentului în ordinea ierarhică a unor
priorităţi.

Benefits of Treatment at Earlier Fibrosis Stages (Metavir Stage Below F2)

Initiating therapy in patients with lower-stage fibrosis augments the benefits of
SVR. In a long-term follow-up study, 820 patients with Metavir stage F0 or F1
fibrosis confirmed by biopsy were followed up for up to 20 years (Jezequel,
2015). The 15-year survival rate was statistically significantly better for those
who experienced an SVR than for those whose treatment had failed or for those
who remained untreated (93%, 82%, and 88%, respectively; P =.003). The study
results argue for consideration of earlier initiation of treatment. Several
modeling studies also suggest a greater mortality benefit if treatment is initiated
at fibrosis stages prior to F3 (Øvrehus, 2015); (Zahnd, 2015); (McCombs, 2015).
http://www.hcvguidelines.org/evaluate/when-whom

Moreover, hepatitis C treatment is the only evidence-based intervention to

prevent liver disease progression. A significant proportion of those with earlier
stages of fibrosis (F0-F2) will ultimately progress to cirrhosis in the absence of
treatment, and there is currently no way to predict which patients will develop
advanced liver disease.
Therefore, for hepatitis C patients with earlier stages of fibrosis, effective
hepatitis C treatment is the only evidence-based strategy to prevent liver disease
progression and complications. In addition, patients who have F2 or milder liver
fibrosis have no residual risk of liver complications due to hepatitis C once they
achieve a cure. Patients who wait until they have F3 or F4 fibrosis require life-
long screening for hepatocellular carcinoma (liver cancer) even if they are cured.
http://nvhr.org/sites/default/files/.users/u27/Harvoni%20comments%20for
%20NYS%20DURB%20November%2020th%20meeting%20with%20endorsing
%20organizations%20-%20Daniel%20Raymond%20110614.docx.

Achieving cure in the earlier stages of fibrosis (F0 or F1) can prevent many of the
complications of advanced liver disease (F3 or F4) such as hepatic
decompensation or hepatocellular carcinoma.
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepa
tology/hepatitis-C/

Initiating treatment earlier for patients with lower stage fibrosis may extend the
benefits of sustained virologic response (SVR). In a long-term follow-up study,
820 patients with Metavir stage F0 or F1 fibrosis confirmed by biopsy were
followed for up to 20 years. The 15-year survival rate was statistically
significantly better for those who experienced SVR compared with those whose
treatment had failed or for those who remained untreated (93%, 82%, and 88%,
respectively.
http://emedicine.medscape.com/article/177792-treatment

Patients with low stage fibrosis (stage 0-3) tend to have higher response rate
(80%) than patients with high stage fibrosis (stage 4-6) (response rate 50%).
http://pubs.sciepub.com/ajcmr/1/4/3/

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able to find it now.

UM222524331US