B.A.R.C.O.S. (Brazilian Argentine Hepatitis C Collaborative Observational Study): Effectiveness and clinical outcomes of HCV treatment with daclatasvir and sofosbuvir with or without ribavirin.

Real-world data evaluating the effectiveness of direct-acting antivirals (DAAs) in hepatitis C virus (HCV) treatment have been reported from different regions. Our aim was to evaluate the effectiveness and clinical outcomes of daclatasvir (DCV) and sofosbuvir (SOF) ± ribavirin (RBV) in a prospective multicentre cohort study including patients from Argentina and Brazil who received DCV/SOF ± RBV for 12 or 24 weeks from 2015 to 2018. Multivariable logistic regression models were carried out to identify factors associated with failure to achieve sustained virologic response (SVR) as a primary end point, and to death, decompensation, hepatocellular carcinoma (HCC) or liver transplantation (LT) as a composite secondary end point. From a total of 1517 patients treated with DCV/SOF, 906 completed 12 weeks post-treatment evaluation and were included in the analysis. Overall SVR12 rate was 96.1% (95% CI: 94.6%-97.2%), and 95% (95% CI: 92.8%-96.6%) in patients with cirrhosis. LT recipients and presence of cirrhosis were independently associated with failure to achieve SVR. During post-SVR12 follow-up, cumulative incidence of the secondary end point was 2.4% (95% CI: 1.5%-3.6%); two patients died from nonliver-related causes and two from HCC, five underwent LT, 12 developed HCC and 17 patients developed hepatic decompensation. Independent variables associated with these composite secondary end points were prior to HCV treatment and presence of cirrhosis. In conclusion, although the high pangenotypic effectiveness of DCV/SOF ± RBV was confirmed in our real-life cohort, patients with compensated and decompensated cirrhosis showed higher risk of non-SVR and complication appearance during treatment or after achieving SVR.

Burden of liver disease in Brazil.

BACKGROUND & AIMS: The burden of liver diseases in the Brazilian population is still unknown. To assess the impact of liver diseases on hospital admissions and mortality within the framework of the Brazilian Unified Health System. METHODS: An analytical ecological observational study was carried out. Secondary data on hospital admissions and deaths because of liver disease were collected from the Unified Health System Information Technology Department (DATASUS) database, between 2001 and 2010. All liver diseases included in the International Classification of Diseases (ICD-10) were reviewed. RESULTS: Liver diseases were the eighth leading cause of death in Brazil. The prevalence of hospital admission because of liver disease during the period of analysis was 0.72% (853 571 hospitalizations), and the mortality rate was 3.34% (308 290 deaths). The mean age at hospital admission and death because of liver disease was 48.05 and 58.10 years respectively. Both hospitalization and death because of liver disease were more common among men, and followed an upward trend over the years. Cirrhosis was the main cause of hospital admissions and death by liver disease in Brazil. The South region of the country had the highest hospital admission rates because of liver disease in Brazil, whereas the Southeast region had the highest mortality rate. CONCLUSION: This study provides evidence of the relevance of liver diseases within the framework of the Brazilian Unified Health System, and shows that the burden of these diseases is not only significant but progressive, at least in terms of hospital admissions and mortality rate.

Perfil do carcinoma hepatocelular em pacientes portadores de hepatopatia crônica pelo vírus C / Profile of the hepatocellular carcinoma in patients with diagnosis of chronic hepatitis / Profile of the hepatocellular carcinoma in patients with diagnosis of chronic hepatitis

Objetivos: Determinar o perfil dos pacientes com diagnóstico de carcinoma hepatocelular (CHC) associado à hepatopatia crônica pelo HCV no HSL-PUCRS. Métodos: Estudo transversal de dados obtidos através da revisão de prontuários. Foram analisados num período de 24 meses os prontuários dos pacientes que tiveram alfa-fetoproteína dosada no Laboratório de Patologia Clínica do HSL. Incluídos aqueles que tiveram diagnóstico de CHC associado à infecção pelo HCV. Resultados: Foram identificados 28 casos de CHC relacionados à infecção pelo HCV. Todos os pacientes apresentavam evidências de hepatopatia crônica. Entretanto, 28,5 eram assintomáticos. O tipo não invasivo de diagnóstico foi empregado em 64,3% dos pacientes. No exame de imagem 78,5% eram do tipo nodular e 57,1% se localizavam no lobo hepático direito. Em 25% o diagnóstico em estágio precoce, permitindo abordagem terapêutica com intenção curativa. Em metade dos pacientes nenhum tipo de tratamento específico contra o tumor foi empregado, por se tratar de neoplasia avançada. Conclusões: O perfil dos pacientes com CHC hepatopatia crônica pelo HCV diagnosticados no HSL-PUCRS é semelhante ao de outras populações ociedentais descritas na literatura. Dois dados diferem da literatura: a alta porcetagem de CHC diagnosticados ainda com a possibilidade de tratamento com intenção curativa e a maior percetagem de caso diagnosticados ainda com possibilidade de tratamento com intenção curativa e a maior porcentagem de casos diagnosticados em pacientes assintomáticos.