In chronic hepatitis C treatment, direct acting antivirals have a strong effect and are well tolerated since 2014, yet it is unclear whether resource-constrained countries have the same achievement. This study aimed at evaluating direct acting antivirals used to treat Turkish chronic hepatitis C patients between the years of 2016 to 2017. Within the one-year period, 101 out of 105 patients reached a sustained virological response rate. The type of direct acting antivirals and treatment length were chosen according to the Health Implementation Guideline of Turkey. The analyses of effectiveness according to therapeutic regimes showed the following sustained virological response rate: Ledipasvir/sofosbuvir and +/-; ribavirin (97%), ombitasvir/paritepravir/dasabuvir and +/-; ribavirin (100%) and sofosbuvir + ribavirin (100%). One patient had virological relapse on the 12th week by the end of the therapy. In this patient, cross-resistance mutation Y93H was specified for the NS5A region. On the other hand, amino acid changes, S282G and C316S, were determined in the NS5B region. The adverse effects were 22% in all patients. Most of them were mild or moderate. The researchers concluded that the results of the highly efficient and well-tolerated therapy with direct acting antivirals could be examples in resource-constrained countries. In addition, resistant variants should be detected after unsuccessful treatment in the management of new therapy options.
Background:
People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting.
Methods
: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed.
Results:
Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%).
Conclusion:
Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis.
Amaç: Pegile-interferon (Peg-IFN) alfa 2a/2b ve nükleozid ve nükleotid analogları (NA), şu anda kronik hepatit B (KHB) tedavisi için onaylanmış iki tedavi yaklaşımıdır. Bugüne kadar birkaç çalışma Peg-IFN ve NA'lar arasındaki tedavinin etkinliğini karşılaştırmıştır. Bu çalışmada, 2006-2016 yılları arasında Türk KHB hastalarında Peg-IFN ve potent NA'ların (entekavir ve tenofovir disoproksil) kümülatif virolojik ve serolojik yanıtlarını karşılaştırarak etkinliklerini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Retrospektif gözlemsel olan bu çalışmada KHB tanılı total 331 hasta (Peg-IFN tedavi grubu, n=62, entekavir tedavi grubu, n=131 ve tenofovir disoproksil tedavi grubu, n=138) değerlendirildi. Bulgular: Virolojik yanıt oranı Peg-IFN tedavi grubunda 12. ayda (%90), NA tedavi grubundan (entekavir için %80, tenofovir disoproksil için %76) daha yüksekti (p<0,05). Peg-IFN'nin 24. ayda kalıcı viral yanıt (KVY) oranı %61 idi (p<0,001). Hepatit B e antijen serokonversiyonu Peg-IFN grubunda (%25) NA grubuna (entekavir için %16, tenofovir disoproksil için %13) göre belirgin yüksekti. Hepatitis B yüzey antijeni (HBsAg) serokonversion oranı Peg-IFN grubunda NA tedavi grubuna göre daha yüksekti (%7,9 vs %0,9 ve %0) (p<0,001). HBsAg serokonversiyonundan sonra anti-HBs titreleri altı aydan fazla korundu. Sonuç: KHB hastalarının uzun sureli takibinde Peg-IFNtedavisi, NA'larına göre daha yüksek KVY ile daha yüksek HBsAg ve HBeAg serokonversiyon ile ilişkili bulundu. Peg-IFN hepatit B virüsün tedavi edildiği yeni bir döneme kadar KHB hastalarında ilk seçenek tedavi yaklaşımı olarak görünmektedir.
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