HCV CHRONIC INFECTION TREATMENT WITH...
Transcript of HCV CHRONIC INFECTION TREATMENT WITH...
HCV CHRONIC INFECTION TREATMENT WITH DAA:
WHO ARE THE PATIENTS THAT ARE NOT ACHIEVING
SUSTAINED VIROLOGIC RESPONSE?
R U I V A L E N T E 1 , R I TA G R Á C I O 2 , M I G U E L A C H E G A 3 , A N A C L Á U D I A M I R A N D A 4 ,
T E R E S A B A P T I S TA 4 , J A I M E N I N A 4 , F E R N A N D O V E N T U R A 4 , S U S A N A P E R E S 4 ,
I S A B E L A L D I R 4 , F E R N A N D O B O R G E S 4 , I S A B E L A N T U N E S 4 , M A R I A J O S É
C A M P O S 5 , J O Ã O P E R E I R A 6 ,
K A M A L M A N S I N H O 4
1 Serviço de Medicina Interna - Hospital Beatriz Ângelo
2 Serviço de Medicina I - Centro Hospitalar de Leiria
3 Serviço de Medicina II - Hospital Prof. Dr. Fernando da Fonseca
4 Serviço de Infecciologia e Medicina Tropical - Hospital de Egas Moniz – Centro Hospitalar de Lisboa
Ocidental
5 Serviço de Urgência – Centro Hospitalar de Lisboa Ocidental
6 Serviço de Medicina 1 – Hospital de Egas Moniz - Centro Hospitalar de Lisboa Ocidental
BACKGROUND
Hepatitis C virus (HCV) is a major healthcare problem.
Recent advances in the HCV treatment after the introduction of direct acting antiviral (DAA) brought a change in the quality of life and life expectancy of these patients.
The aim of this study is to characterize the
patients treated with DAA for chronic
hepatitis C who did not achieve sustained
virological response (SVR), with special
focus on those HIV co-infected.
MATERIALS & METHODS
Retrospective, observational study.
Individual clinical file review of HCV chronically
infected patients, with regular follow-up on an out-
patient Infectious Diseases clinic who were
eligible to start DAA treatment.
From1st January 2015 to 30 April 2017.
Demographic and HCV infection features, liver
disease staging, therapeutic regimen and
response to therapy.
Data was analyzed using Microsoft Office Excel
2010.
RESULTS
532 patients proposed to hepatitis C DAA treatment
1st January 2015 - 30 April 2017
Tabela
DEMOGRAPHICS
Mean age [min;max] 49,8 years [33;78]
Men / Women (%) 76% / 24%
Mean time HCV
diagnosis 14,2 years [1;30]
HIV co-infection (n, %) 338 (63,5)
HCV treatment
experienced (n, %) 157 (29)
TRANSMISSION n (%)
IV drug use 353 (66%)
Sexual 37 (7%)
Transfusional 6 (1%)
Unkown 37 (7%)
NA 99 (18%)
HCV GENOTYPE n (%)
G1 323 (60%)
G2 9 (1,2%)
G3 99 (18%)
G4 100 (18%)
G6 1 (0,1%)
FIBROSIS
(METAVIR) n (%)
≤ F2 222 (42%)
F3 246 (46%)
F4 54 (10%)
MELD SCORE >= 10 63 (12%) NA: Not available
RESULTS
532 patients proposed to hepatitis C DAA treatment
464 (87%) started DAA 68 (13%) did not start
DAA
5 (7%) lost
to follow up 430 (81%) completed tx
359 (67,5%) performed
12/24 week post tx
evaluation
58 (85%)
waiting tx
1st January 2015 - 30 April 2017
5 (7%) died
Sepsis n=2*
Lung Cancer n=1*
Lymphoma n=1*
Chronic liver disease
n=1*
Global SVR 96,1%
(345/359)
3 died
31 OT
Sepsis n=1
ESLD n=1*
HCC n=1*
* HIV coinfected
18%
0 50 100 150 200 250 300 350 400
OMB/PTVr/DBV+RBV
OMB/PTVr/DBV
SOF+DAC
Other
SOF/LED+RBV
SOF+RBV
SOF/LED
HIV/HCV HCV Global
RESULTS
532 patients proposed for hepatitis C DAA treatment
74%
1st January 2015 - 30 April 2017
RESULTS
532 patients proposed for hepatitis C DAA treatment
98% 100% 100% 100%
84%
100% 97% 97% 100% 98% 96%
0%
G1a G1b G2 G3 G4 G6
VHC VHC/VIH
430 (81%) completed tx 359 (67,5%) performed 12/24 w
post tx evaluation SVR
Global SVR
96,1%
1st January 2015 - 30 April 2017
55/56
13/16 48/50 1/1
25/25 55/56 118/122 31/30
4/4 4/4
26/26 38/39
13/16 48/50
1/1
RESULTS
DEMOGRAPHICS
Mean age
[min;max] 54 [43;78]
Men / Women 93% / 7%
HIV co-infection 9 (64 %)
HCV treatment
experienced 11 (78%)
TRANSMISSION n (%)
IV drug use 8 (57,14)
NA 2 (14,2)
Transfusional 1 (7,14)
Unkown 3 (21,4)
14 (3,9%) patients did not achieve sustained virologic response
(SVR)
GENOTYPE n (%)
G1 5 (35)
G2 1 (7)
G3 4 (28)
G4 4 (28)
FIBROSIS (METAVIR) n (%)
≤ F2 7 (50)
≥ F3 7 (50)
MELD SCORE > 10 0
RESULTS
14 (3,9%) patients did not achieve sustained virologic response
(SVR)
4
1 1
4 4
G1a G1b G2 G3 G4
2
5
6
1
F2 F2/F3 F3 F4
GENOTYPE FIBROSIS SCORE
50%
RESULTS
14 (3,9%) patients did not achieve sustained virologic response
(SVR)
SOFOSBUVIR+LEDIPASVIR SOFOSBUVIR+RIBAVIRIN
DAA ORIGINAL REGIMEN
9 Patients (G1/G4)
5 Cirrhotic - 24 Wks
4 non Cirrhotic - 12 Wks
4 Patients (G2/G3)
4 Cirrhotic - 24 Wks
SOFOSBUVIR+DACLATASVIR
1 Patient (G3)
Non-Cirrhotic - 12 Wks
RESULTS
14 (3,9%) patients did not achieve sustained virologic response
(SVR)
SOF+LE
D
SOF+RB
V
ORIGINAL REGIMEN PROPOSED RETREATMENT
24 wks
12 wks
3
5
SOF+DAC+RBV
SOF+GZV/EBR+RBV
RETREATMENT REGIMENS WERE SOLICITED FOR 8 PATIENTS AT
PRESENT DATE
CONCLUSIONS
The treatment of hepatitis C virus infection was
revolutionized by the introduction of the direct antiviral
agents, which achieve high rates of virologic response.
Although the treatment is very effective there are still
patients who do not respond to therapy.
The present study reveals a low relapse rate (3,9%) and
the majority of non-responders were men, previously
treated with PEGIFN+RIB, HCV infected by intravenous
drug use, co-infected with HIV and have
moderate/advanced hepatic fibrosis (F2-F3).
Acknowledgements
Fernando Borges
Fernando Ventura
Jaime Nina
Isabel Antunes
Isabel Aldir
Teresa Baptista
Ana Cláudia Miranda
Susana Peres
Virginia Moneti
Telma Azevedo
Director: Kamal Mansinho
Molecular Biology: Perpétua Gomes
Pharmaceutical: João Rijo, Helena Farinha
Secretary: Hermínia Calixto
Pedro Brogueira
Joana Silva
João Vaz Alves
Karen Pereira
Sara Grazina
João Torres
Margarida Cardoso
Miguel Achega
Rita Grácio