Indications and contraindications for treatment of hepatitis C virus infections
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México" "etiqueta" => "1" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Address for correspondence:" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Treatment indications</span><p id="p0005" class="elsevierStylePara elsevierViewall">All patients with chronic hepatitis C virus (HCV) infections are considered prospects for antiviral treatment to prevent progression of liver damage to cirrhosis or hepatocarcinoma. The consensus is that such treatment must entail a combination of interferon alfa and rivabirin. <a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Treatment is indicated for anti-HCV-positive, HCV RNA-positive patients with increased serum aminotransferase levels and for whom there is histological evidence of chronic hepatitis, provided there are no specific contraindications. <a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The following should be taken into consideration when deciding whether to initiate treatment: age, comorbidities, extrahepatic manifestations such as cryoglobulinemia and glomerulonephritis, and quality of life.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It is important to note that decisions on whether treatment should be implemented must not be based on the way in which the CHV was acquired or the presence or absence of symptoms. Whether HCV genotypes or HCV RNA levels are valid indicators for treatment is the subject of debate.</p><p id="p0010" class="elsevierStylePara elsevierViewall">Patients with genotypes 2 and 3 may be treated at any stage of the disease because of the high frequency of sustained virological response in these patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">Patients with liver cirrhosis and hepatitis C who comply with the criteria mentioned previously and who have no clinical history of decompensation such as ascites, bleeding varices, severe malnutrition, or grossly abnormal laboratory indexes are also prospects for treatment.</p><p id="p0020" class="elsevierStylePara elsevierViewall">The decision to initiate a treatment must be made on an individual basis for patients who are older than 65 years, have persistently normal aminotransferase levels, display no histological evidence of fibrosis or portal fibrosis (Metavir 1),<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> have HIV or HBV coinfection,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> or fail to respond to or relapse from treatment with nonpegylated interferon alfa with or without ribavirin. In the last-mentioned instance, it is advisable to obtain histological evidence of the grade of fibrosis or cirrhosis before making a decision.</p><p id="p0025" class="elsevierStylePara elsevierViewall">Hepatitis C patients who are prospects for renal transplantation should undergo treatment prior to transplantation. As frequent adjustments of drug doses are required for patients with chronic renal failure, it is advisable to obtain histological confirmation of the stage of liver disease.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="p0030" class="elsevierStylePara elsevierViewall">Antiviral treatment of patients awaiting liver transplantation may be considered to stabilize or improve liver function. In liver transplant patients with reinfected grafts, the trend is to initiate treatment at an early stage to prevent the progression of this condition. In such cases, it is necessary to take a liver biopsy. Treatment is often extended for longer than usual. The issue of maintenance therapy with long-term follow-ups is still the subject of research.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="p0035" class="elsevierStylePara elsevierViewall">Treatment of children with hepatitis C should be carried out in controlled clinical studies.</p><p id="p0040" class="elsevierStylePara elsevierViewall">At present, treatment of cases of acute hepatitis C with pegylated interferon or interferon alfa monotherapy is considered justified.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contraindications</span><p id="p0045" class="elsevierStylePara elsevierViewall">Treatment is not recommended for hepatitis C patients with clinically decompensated liver cirrhosis. Treatment is contraindicated in the presence of pregnancy, severe depression, significant neuropsychiatric syndromes, alcohol abuse, drug addiction, active autoimmune diseases such as lupus erythematosus, rheumatoid arthritis or psoriasis, severe anemia, liver failure, failure to apply contraceptive measures during treatment, uncompensated dysthyroidism, recent organ transplantation.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="p0050" class="elsevierStylePara elsevierViewall">The issues and recommendations of the consensus panel are as follows</p><p id="p0055" class="elsevierStylePara elsevierViewall">1. Who are the ideal prospects for treatment?</p><p id="p0060" class="elsevierStylePara elsevierViewall">Patients who are anti-HCV positive and have persistently elevated ALT levels and viral loads with a diagnosis of chronic hepatitis or liver cirrhosis child A associated to platelet levels higher than 75,000. hemoglobin > 12 g/dL. Patients without preexisting neutropenia and in whom there is an absence of decompensated associated diseases.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">The quality of evidence for this recommendation was given a rating of 2</span><p id="p0065" class="elsevierStylePara elsevierViewall">Combined antiviral treatment (Pegylated interferon plus Ribavirin) is contraindicated in instances of:</p><p id="p0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="li0005"><li class="elsevierStyleListItem" id="list0005"><span class="elsevierStyleLabel">•</span><p id="p0075" class="elsevierStylePara elsevierViewall">decompensate psychiatric disease,</p></li><li class="elsevierStyleListItem" id="list0010"><span class="elsevierStyleLabel">•</span><p id="p0080" class="elsevierStylePara elsevierViewall">decompensate diabetes mellitus,</p></li><li class="elsevierStyleListItem" id="list0015"><span class="elsevierStyleLabel">•</span><p id="p0085" class="elsevierStylePara elsevierViewall">decompensate arterial hypertension,</p></li><li class="elsevierStyleListItem" id="list0020"><span class="elsevierStyleLabel">•</span><p id="p0090" class="elsevierStylePara elsevierViewall">decompensate hemoglobinopathy,</p></li><li class="elsevierStyleListItem" id="list0025"><span class="elsevierStyleLabel">•</span><p id="p0095" class="elsevierStylePara elsevierViewall">decompensate autoimmune diseases,</p></li><li class="elsevierStyleListItem" id="list0030"><span class="elsevierStyleLabel">•</span><p id="p0100" class="elsevierStylePara elsevierViewall">immunosuppressive treatment (nontransplanted patients),</p></li><li class="elsevierStyleListItem" id="list0035"><span class="elsevierStyleLabel">•</span><p id="p0105" class="elsevierStylePara elsevierViewall">thrombocytopenia (< 50,000 platelets per microliter), and</p></li><li class="elsevierStyleListItem" id="list0040"><span class="elsevierStyleLabel">•</span><p id="p0110" class="elsevierStylePara elsevierViewall">neutropenia (< 750 cells per milliliter).</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">The quality of evidence for this recommendation was given a rating of 2</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Special indications</span><p id="p0115" class="elsevierStylePara elsevierViewall">Patients with neutropenia (< 750 cells per milliliter), thrombocytopenia (< 50,000 platelets per microliter) and other hematological pathologies in transplant and research programs must be treated individually by physicians with experience in the management of such patients.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">The quality of evidence for this recommendation was given a rating of 3</span><p id="p0120" class="elsevierStylePara elsevierViewall">Should patients receiving immunosuppressive treatment for pathologies other than liver transplants (e.g., lupus and renal transplants) be considered for treatment?</p><p id="p0125" class="elsevierStylePara elsevierViewall">Such patients should be given the opportunity of treatment. However, they should be treated by physicians with experience in the management of this type of patient.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">The quality of evidence for this recommendation was given a rating of 2</span><p id="p0130" class="elsevierStylePara elsevierViewall">Which physicians should treat patients infected with HCV?</p><p id="p0135" class="elsevierStylePara elsevierViewall">Gastroenterologists, internists, infectologists, and hepatologists with experience in the management of these patients.</p><p id="p0140" class="elsevierStylePara elsevierViewall">The quality of evidence for this recommendation was given a rating of 3</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Treatment indications" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Contraindications" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "The quality of evidence for this recommendation was given a rating of 2" ] 3 => array:3 [ "identificador" => "sec0020" "titulo" => "The quality of evidence for this recommendation was given a rating of 2" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Special indications" ] ] ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "The quality of evidence for this recommendation was given a rating of 3" ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "The quality of evidence for this recommendation was given a rating of 2" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C infection: eligibility for antiviral therapies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Delwaide J" 1 => "El Saqouda R" 2 => "Gerard C" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Gastroenterol Hepatol" "fecha" => "2005" "volumen" => "17" "paginaInicial" => "1185" "paginaFinal" => "1189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16215430" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 28 | 10 | 38 |
| 2024 October | 235 | 32 | 267 |
| 2024 September | 197 | 50 | 247 |
| 2024 August | 151 | 32 | 183 |
| 2024 July | 191 | 48 | 239 |
| 2024 June | 273 | 56 | 329 |
| 2024 May | 207 | 41 | 248 |
| 2024 April | 251 | 35 | 286 |
| 2024 March | 211 | 46 | 257 |
| 2024 February | 223 | 62 | 285 |
| 2024 January | 250 | 45 | 295 |
| 2023 December | 209 | 80 | 289 |
| 2023 November | 286 | 71 | 357 |
| 2023 October | 243 | 51 | 294 |
| 2023 September | 231 | 26 | 257 |
| 2023 August | 218 | 29 | 247 |
| 2023 July | 239 | 42 | 281 |
| 2023 June | 288 | 47 | 335 |
| 2023 May | 331 | 52 | 383 |
| 2023 April | 325 | 22 | 347 |
| 2023 March | 357 | 40 | 397 |
| 2023 February | 210 | 24 | 234 |
| 2023 January | 256 | 20 | 276 |
| 2022 December | 246 | 19 | 265 |
| 2022 November | 333 | 17 | 350 |
| 2022 October | 361 | 28 | 389 |
| 2022 September | 305 | 24 | 329 |
| 2022 August | 232 | 16 | 248 |
| 2022 July | 179 | 15 | 194 |
| 2022 June | 179 | 13 | 192 |
| 2022 May | 209 | 12 | 221 |
| 2022 April | 306 | 16 | 322 |
| 2022 March | 248 | 9 | 257 |
| 2022 February | 253 | 15 | 268 |
| 2022 January | 188 | 9 | 197 |
| 2021 December | 220 | 14 | 234 |
| 2021 November | 280 | 20 | 300 |
| 2021 October | 213 | 14 | 227 |
| 2021 September | 206 | 11 | 217 |
| 2021 August | 205 | 13 | 218 |
| 2021 July | 221 | 9 | 230 |
| 2021 June | 258 | 9 | 267 |
| 2021 May | 210 | 13 | 223 |
| 2021 April | 408 | 29 | 437 |
| 2021 March | 272 | 14 | 286 |
| 2021 February | 213 | 21 | 234 |
| 2021 January | 143 | 11 | 154 |
| 2020 December | 148 | 12 | 160 |
| 2020 November | 139 | 10 | 149 |
| 2020 October | 94 | 11 | 105 |
| 2020 September | 106 | 6 | 112 |
| 2020 August | 93 | 11 | 104 |
| 2020 July | 92 | 3 | 95 |
| 2020 June | 125 | 10 | 135 |
| 2020 May | 63 | 4 | 67 |
| 2020 April | 56 | 2 | 58 |
| 2020 March | 67 | 5 | 72 |
| 2020 February | 18 | 1 | 19 |
| 2020 January | 4 | 5 | 9 |
| 2019 December | 8 | 4 | 12 |
| 2019 November | 0 | 2 | 2 |
| 2019 October | 4 | 2 | 6 |
| 2019 September | 8 | 3 | 11 |
| 2019 August | 8 | 1 | 9 |
| 2019 July | 2 | 10 | 12 |
| 2019 June | 2 | 6 | 8 |
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