[Effectiveness of second-generation direct-acting antivirals in chronic hepatitis C]. / Efectividad de los antivirales de acción directa de segunda generación en el tratamiento de la hepatitis C crónica.

BACKGROUND: Second-generation direct-acting antivirals (DAA) have shown high sustained virologic response (SVR) for the treatment of chronic hepatitis C in clinical trials. The objective of this study is to estimate DAA effectiveness in treatment of this disease. METHODS: Hepatitis C virus (HCV) monoinfected patients and HCV-human immunodeficiency virus (HIV) coinfected pa-tients who started interferon-free DAA based regimens during 2015 were included. The primary effectiveness outcome was SVR, defined as an undetectable viral load 12 weeks after the end of treatment. RESULTS: A total of 293 patients were enrolled, and 52 (17.7%) were HIV coinfected. HCV 1b genotype was the most prevalent in monoinfected patients (41.5%) and 1a in HIV coinfected patients (40.4%). The proportion of cirrhosis was higher among HIV coinfected patients (69.2% vs 41.1%; p<0.0001), mostly Child-Pugh A. SVR was achieved by 96.9% of patients (284/293), in an intention-to-treat analysis (CI 95%: 94.9-98.9), in which just 4 people had virologic failure. Both naïve and pretreated patients had SVR higher than 95%, and in most of subgroups, according to the presence of cirrhosis, HIV coinfection and HVC genotype, effectiveness rates were near or above 90%. CONCLUSIONS: DAA are highly effective, with similar or higher rates of SVR than that found in clinical trials, and even among difficult to treat populations.

Ischemic hepatitis secondary to cardiac tamponade, a rare cause / Hepatitis isquémica secundaria a taponamiento cardiaco, una causa poco frecuente.

Ischemic hepatitis (IH) is a rare entity, usually associated with hypoperfusion secondary to low cardiac output (congestive heart failure, acute myocardial infarction or dilated cardiomyopathy), followed in frequency by respiratory insufficiency and sepsis. A 49-year-old man presented at the emergency room with progressive dyspnea and hypotension, objectifying a significant increase in transaminases (aspartate transferase 5.550 U / L, alanine transferase 3.826 U / L) and LDH (10.375 U / L). Liver Doppler ultrasound was normal. The echocardiogram confirmed the suspected diagnosis of massive pericardial effusion. Cardiac tamponade is a rare cause for this clinical picture. In the case of our patient, rapid diagnosis and urgent pericardiocentesis led to his prompt recovery.