RESUMO
Chronic obstructive pulmonary disease (COPD) is a preventable, treatable disease with significant extrapulmonary manifestations that could affect negatively its course in some patients. Hepatitis C virus infection (HCV), on the other hand, is associated with a number of extrahepatic manifestations. COPD patients have increased prevalence of HCV and patients with HCV, especially older ones, have increased prevalence and faster progression of COPD. HCV infection exerts long-term effects on lung tissue and is an additional risk factor for the development of COPD. The presence of HCV is associated with an accelerated loss of lung function in COPD patients, especially in current smokers. COPD could represent extrahepatic manifestation associated with HCV infection. The aim of this article was to review the literature on prevalence of HCV in COPD and vice versa, pathogenetic link and the consequences of their mutual existence.
Assuntos
Hepatite C Crônica/epidemiologia , Hepatite C Crônica/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Distribuição por Idade , Comorbidade , Progressão da Doença , Feminino , Hepatite C Crônica/diagnóstico , Humanos , Masculino , Prevalência , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Medição de Risco , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
We observed a sustained viral response (SVR) of ombitasvir/paritaprevir/ritonavir, dasabuvir and ribavirin therapy, for 12 wk, in two cases with compensated liver cirrhosis and fully destroyed early hepatocellular carcinoma (HCC). Patients were infected with hepatitis C virus (HCV) genotype 1b and were previous null responders/relapsers to interferon-alpha/ribavirin (IFN/RBV). There was a rapid suppression of HCV RNA to undetectable levels within the first two treatment weeks. SVR was achieved even after marked reduction of the RBV dose. The treatment was well tolerated. Both subjects experienced worsening of liver disease during therapy, in different patterns: severe, transient, predominantly direct hyperbilirubinemia without cytolysis (case 1) or progressive increase of aminotransferases (grade 4) without severe hyperbilirubinemia (case 2). Adverse events spontaneously resolved. The patients remained in a good clinical condition without hepatic decompensation. There was no re-occurrence of HCC. This is the first report for treatment of HCV cirrhosis after complete HCC destruction.
Assuntos
Anilidas/uso terapêutico , Antivirais/uso terapêutico , Carbamatos/uso terapêutico , Carcinoma Hepatocelular/terapia , Hepatite C/tratamento farmacológico , Cirrose Hepática/tratamento farmacológico , Neoplasias Hepáticas/terapia , Compostos Macrocíclicos/uso terapêutico , Ribavirina/uso terapêutico , Ritonavir/uso terapêutico , Sulfonamidas/uso terapêutico , Uracila/análogos & derivados , 2-Naftilamina , Idoso , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/virologia , Ciclopropanos , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/efeitos dos fármacos , Hepacivirus/genética , Hepatite C/sangue , Hepatite C/complicações , Hepatite C/diagnóstico , Humanos , Lactamas Macrocíclicas , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Cirrose Hepática/virologia , Testes de Função Hepática , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/virologia , Masculino , Prolina/análogos & derivados , RNA Viral/sangue , RNA Viral/genética , Resultado do Tratamento , Uracila/uso terapêutico , Valina , Carga ViralRESUMO
The treatment with lamivudine leads to drug resistant mutations in 19 to 70% cases after 1- and 5-year therapy, respectively, associated with the risk of severe rebound of liver disease with alaninaminotransferase flare. In this situation, adefovir should be added, but this drug is not available in every country. We report three cases where we avoided the expected hepatic flare-ups by using IFN and isoprinosine. Based on this empirical experience, we suggest that the new drug has to be administered one month before discontinuation of lamivudine. Prospective trials are mandatory.