Hepatite C em pacientes co-infectados pelo vírus da imunodeficiência humana. Revisão sobre o tema e experiência de um ambulatório brasileiro

O virus da hepatite C e o HIV compartilham os mesmos mecanismos de transmissão. A prevalência da infecção pelo vírus da hepatite C em pacientes co-infectados pelo HIV varia em diferentes regiões do mundo, a depender dos diferentes fatores de exposição para ambos os vírus. A co-infecção com o HIV acelera a progressão da doença causada pelo vírus da hepatite C, agrava a progressão da infecção causada pelo HIV e aumenta o risco de transmissão do vírus da hepatite C. Portanto, a atenção clínica e o tratamento da infecção pelo vírus da hepatite C deveriam ser prioridade nas unidades de atendimento a pacientes infectados pelo HIV. O manejo clínico desses pacientes envolve procedimentos diagnósticos específicos e equipe médica treinada para esse fim. O tratamento dessa condição deve seguir critérios clínicos e laboratoriais específicos. Atualmente já são disponíveis medicamentos para o tratamento da hepatite C em pacientes co-infectados pelo HIV.Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share the same transmission mechanisms. The prevalence of HCV in the HIV-infected population varies from region to region, throughout the world, depending on different exposure factors to both viruses. Co-infection with HIV accelerates the progression of the disease caused by HCV, appears to worsen the progression of the HIV infection and increases HCV transmission. Therefore, clinical management and treatment of HCV is a priority in medical facilities that receive HIV-infected patients. Clinical management of these patients involves specific diagnostic procedures and appropriately trained medical staff. The indication of treatment should meet specific clinical and laboratory criteria. There are a number of drugs currently available to treat hepatitis C in co-infected patients

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil : a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-totreat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, po0.001) and a higher incidence of serious adverse events (50.7% vs. 34.8%, po0.001). Multivariate analysis revealed that sustained viral response was associated with the absence of cirrhosis, viral recurrence after previous treatment, pretreatment platelet count greater than 100,000/mm3, and achievement of a rapid viral response. Female gender, age465 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts