RESUMO
Hepatitis C is a common cause of end-stage liver disease, and the main indication for liver transplantation in Latin America. Treatment of hepatitis C infected patients improves important long-term outcomes as mortality. Sustained viral response is reached in near 50% of patients with the previous management based in pegylated interferon and ribavirin. Recently new drugs were available increasing sustained viral response significantly, changing the standard of care to triple therapy. This guidelines provides a framework for practitioner in Latin America, to the management of patients with hepatitis C chronic infection.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Oligopeptídeos/uso terapêutico , Prolina/análogos & derivados , Inibidores de Proteases/uso terapêutico , Ribavirina/uso terapêutico , Quimioterapia Combinada , Testes Genéticos , Hepacivirus , Hepatite C Crônica/diagnóstico , Humanos , Interferons , Interleucinas/genética , Polietilenoglicóis , Prolina/uso terapêutico , Carga ViralRESUMO
Chronic Hepatitis C relapse after liver transplantation can lead to graft failure within a short time period. The high efficacy and good safety profile of direct-acting antivirals has led to consensual recommendations for using interferon-free treatment after liver transplantation. However, pegylated interferon may still be required for genotype 3 non-responders. We treated a liver graft recipient with grade 1 fibrosis in the biopsy with daclatasvir and sofosbuvir for 12 weeks. He did not respond and progressed to grade 3 fibrosis. Lacking other options, we obtained a sustained virological response with pegylated interferon, ribavirin and sofosbuvir for 12 weeks. The combination of pegylated interferon, ribavirin and sofosbuvir is a viable option after the failure of direct acting antivirals in economically disadvantaged countries.
Assuntos
Antivirais/administração & dosagem , Hepatite C Crônica/tratamento farmacológico , Interferon alfa-2/administração & dosagem , Interferon-alfa/administração & dosagem , Polietilenoglicóis/administração & dosagem , Ribavirina/administração & dosagem , Sofosbuvir/administração & dosagem , Idoso , Quimioterapia Combinada , Genótipo , Hepacivirus/genética , Humanos , Transplante de Fígado , Masculino , Proteínas Recombinantes/administração & dosagem , Carga ViralRESUMO
A hiperamilasemia após a colangiopancreatografia endoscópica retrógrada ocorre em 25 a 50% dos casos. Na tentativa de explicar esse aumento foram estudados, através de endoscopia digestiva alta, 107 pacientes com suspeita de doença esofagogástrica, determinando a atividade da amilase antes e após o procedimento. Em 33% dos casos houve aumento da atividade da enzima, sugerindo, entäo, ser esta dependente de seu componente salivar