Ledipasvir/sofosbuvir with or without ribavirin for the treatment of chronic hepatitis C genotype 1: A pairwise meta-analysis.

BACKGROUND AND AIM: Ledipasvir with sofosbuvir (LED/SOF) for the treatment of patients infected with genotype 1 hepatitis C virus can be used with or without ribavirin (RBV). RBV is well known to promote significant adverse events (AE). The aim of this study was to compare the efficacy and safety of treatment with LED/SOF, with or without RBV, in patients infected with hepatitis C virus genotype 1. METHODS: We performed a systematic review followed by a pairwise meta-analysis including randomized controlled trials that reported efficacy (rapid virological response, sustained virological response at 4 and 12 weeks post-treatment (SVR4 and 12), and viral relapse) and safety outcomes (any AE, serious AE, discontinuation owing to AE, anemia, and rash). It was performed a subgroup analysis evaluating the SVR12 including only cirrhotic patients. Results were reported as risk ratios (RR) and with 95% confidence intervals (95% CI). RESULTS: Seven randomized controlled trials were analyzed. LED/SOF with RBV showed a worse safety profile when compared with LED/SOF without RBV for the following outcomes: any AE (RR 0.56 [95% CI 0.46-0.69]), anemia (RR 0.08 [95% CI 0.04-0.17]), and rash (RR 0.35 [95% CI 0.19-0.65]). No significant differences were observed regarding serious AE, rapid virological response, SVR4, SVR12, or viral relapse. The subgroup analysis did not show significant differences between either treatment groups. CONCLUSION: Administration of LED/SOF + RBV to treatment-naïve patients with or without cirrhosis, and non-cirrhotic treatment-experienced patients, did not promote significant additional benefits. Furthermore, it is still unclear whether cirrhotic treatment-experienced patients could benefit from combined therapy.

Indicaçöes para transplante hepático / Indications of liver transplantation

Transplante hepático é hoje uma forma aceita e bem sucedida de tratamento de doença hepática avançada. Há contudo desconhecimento de grande parcela da classe médica a respeito das suas indicaçöes e contra-indicaçöes, bem como aos resultados deste procedimento. Tem este trabalho o propósito de delinear as indicaçöes e contra-indicaçöes do transplante hepático

High prevalence of hepatitis c virus infection in chronic hemodialysis patients

Hepatitis C virus (HCV) infection is very common among hemodialysis (HD) patients. Transmission of Infection in this setting has been related to the number of blood transfusions, the duration of hemodialysis and to nosocomial transmission of virus in the dialysis unit. We conducted a study of 74 HD patients to determine the frequency of HCV at a single point in time (cross-sectional analysis), and to evaluate the association between HCV infection and patients' demographic, clinical and biochemical features. Serum samples were tested for anti-HCV antibodies using a third-generation enzyme-linked immunosorbent assay (ELISA). In the case of a positive result, third-generation recombinant immunoblot and HCV RNA detection by polymerase chain reaction (PCR) tests were performed. Collected data included the patient's age, gender, time on HD, number of blood transfusions and serum alanine aminotransferase (ALT) activity. Twenty-nine patients (29/74.4 percent) were found to be HCV positive using a third generation ELISA assay. From these 29 patients, 27 were also positive by recombinant immunoblot assay and 2 patients had indederminate results. In the subgroup of anti-HCV ELISA positive, 20 (69 percent) of the 29 patients had detectable HCV RNA. The HCV RNA positive patients had received more blood transfusions (15ñ3 vs.5ñ1 units of packed red blood cells, p<0.0001) and had been on HD for a longer period of time than the HCV RNA negative patients (65ñ32 vs.32ñ29 months, p<0.0001). Mean serum ALT levels were significantly higher in the HCV RNA positive group (30ñ18 vs.15ñ9,p<0.0001). We were unable to determine the most likely mode of transmission in our unit, but these results emphasize the need for strict adherence to blood collecting and handing precautions, careful attention to hygiene in the dialysis units, and sterilization of dialysis machines in order to properly combat this frequent infection.

Transplante hepático: experiência com 35 casos / Liver transplantation: experience with 35 cases

No período de 24 de setembro de 1991 a 31 de setembro de 1995 foram realizados 35 transplantes hepáticos no Hospital de Clínicas da Universidade Federal do Paraná. A idade dos pacientes variou de 6 a 57 anos, com média de 26 anos. As indicaçöes do procedimento foram bastante variáveis e as mais comuns foram a cirrose criptogenética, cirrose por hepatite autoimune, cirrose alcoólica por hepatite C. Trinta e quatro implantes foram realizados de 1 a 4 horas após a retirada do fígado do doador e um 12 horas após. O implante foi realizado com todo o fígado em 34 pacientes e com os segmentos I, II, III e IV em um paciente. As complicaçöes pós-operatórias mais frequentes foram a rejeiçäo celular, insuficiência renal aguda, síndrome da angústia respiratória do adulto e trombose da artéria hepática. Seis pacientes (17 por cento) foram a óbito durante a internaçäo hospitalar e sete (20 por cento) faleceram no pós-operatório tardio (seguimento de 1 a 48 meses). As causas de óbito foram múltiplas e a principal foi a infecçäo viral. A qualidade de vida após 6 meses de transplante é muito boa, com o paciente retornando às suas atividades normais