A review of the treatment of chronic hepatitis C virus infection in cirrhosis;

StephenW

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              A review of the treatment of chronic hepatitis C virus infection in cirrhosis; Vezali E, Aghemo A, Colombo M; Clinical Therapeutics 32 (13), 2117-38 (Dec 2010)   

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      Source: Clin Ther
      Stars: 26      

Tags:
• Cirrhosis
• Hepatitis
• interferon
• interferon alfa-2b
• peginterferon alfa-2a
• peginterferon alfa-2b
• peginterferon beta-1a
• ribavirin
  

            Background: Cirrhosis developing during chronic infection with the hepatitis C virus (HCV) poses a risk of anticipated liver-related death, therefore representing a dominant indication to anti-HCV therapy. Objective: This review highlights the efficacy and safety of treatment of HCV infection in cirrhotic patients with respect to the clinical stage of the disease. Methods: The PubMed, MEDLINE, EMBASE, and Cochrane databases, as well as the conference proceed- ings from the annual meetings of the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver, were searched for articles published in English from January 1990 through May 2010, fulfilling the following criteria: (1) randomized, prospective observational, retrospective, or meta-analysis; (2) involving adult patients with chronic HCV infection; and (3) data (fibrosis stage, treatment regimen, efficacy, safety) available for cirrhotics. Reviews were excluded. Search terms included chronic hepatitis C, fibrosis, cirrhosis, interferon alfa, ribavirin, hepatocellular carcinoma, and liver decompensation. Results: Forty-five studies were identified. The rates of sustained virologic response to pegylated interferon in combination with ribavirin ranged from 10% to 44% for HCV genotypes 1/4 to 33% to 72% for genotypes 2/3 in compensated cirrhosis, while falling to 0% to 16% and 44% to 57%, respectively, in the decompensated stage, compared with 29% to 55% for genotypes 1/4 and 70% to 80% for genotypes 2/3 in noncirrhotic patients (compensated cirrhosis vs no cirrhosis: P<0.001 for genotypes 1/4 and P = 0.002 for genotypes 2/3; decompensated cirrhosis vs no cirrhosis: P<0.001 for all genotypes). HCV clearance was associated with a reduced risk of liver decompensation, hepatocellular carcinoma development, liver-related mortality, and hepatitis recurrence after liver transplantation. Treatment during compensated cirrhosis proved to be most cost-effective versus treatment after decompensation or a no-treatment strategy. Headache (54%), irritability (38%), fatigue (34%), and nausea (30%) were the most common adverse events in compensated patients, while anorexia (100%), fatigue (59%), neutropenia (53%), and thrombocytopenia (50%) were most common in decompensated patients. Conclusions: Anti-HCV treatment in cirrhotic patients was less effective than in noncirrhotic patients. Viral eradication reduced the risk of liver complications and improved survival in noncirrhotics. Based on effectiveness and tolerability data, therapy has a significant effect in patients with compensated cirrhosis, while decompensated patients need to weigh the risks versus benefits of treatment.
      
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StephenW

DocGuide
阿的慢性丙型肝炎病毒感染的治疗肝硬化的审查; Vezali é，Aghemo甲，科伦坡米;临床治疗32（13），2117-38（2010年12月）
来源：临床有
明星：26

      标签：
          Ø肝硬化
          Ø肝炎
          Ø干扰素
          Ø干扰素α- 2b干扰素
          Ø聚乙二醇干扰素α- 2a的
          Ø聚乙二醇干扰素α- 2b干扰素
          Ø长效干扰素β- 1a的
          Ø利巴韦林

背景：肝硬化在与丙型肝炎病毒（HCV）慢性感染的发展带来了预期的肝脏相关死亡的危险，因此占了主导指示作用抗HCV治疗。目的：本文综述了有关该疾病的临床分期的疗效和治疗丙型肝炎病毒感染在肝硬化病人的安全。方法：检索PubMed，MEDLINE数据库，EMBASE和Cochrane资料库，以及会议的进行，从美国协会，为肝脏疾病，为肝脏研究欧洲研究协会年会英格斯，以及亚洲太平洋对肝脏的研究协会，进行了全面搜查，从1990年1月已发布在2010年5月通过英语文章，符合下列条件：（1）随机，前瞻性观察性，回顾性的，或元分析，（2）涉及与慢性成人患者丙型肝炎病毒感染，（3）数据（纤维化分期，治疗方案，疗效，安全）为肝硬化患者提供。评论被排除在外。搜索范围包括慢性丙型肝炎，肝纤维化，肝硬化，干扰素，利巴韦林，肝癌，肝失代偿。结果：45个研究进行了鉴定。持续病毒学应答与聚乙二醇干扰素联合利巴韦林组合率介乎10％至44％的丙型肝炎病毒基因型1 / 4到33％至72％的代偿性肝硬化基因型2 / 3，而下降到0％至16％， 44％至57％，分别在失代偿期，则有29％至55％的基因型1 / 4，在非肝硬化患者的基因型2 / 3的70％至80％（相较于无肝硬化代偿性肝硬化：对“0.001为基因型1 / 4和P = 0.002基因型2 / 3;肝硬化失代偿期肝硬化与没有：对所有基因型磷“0.001）。丙型肝炎病毒清除率会提高肝脏失代偿，肝癌的发展，肝脏相关死亡率，肝移植术后肝炎复发的风险降低。代偿性肝硬化治疗过程中被证明是最具成本与失代偿后或无有效治疗的治疗策略。头痛（54％），烦躁（38％），乏力（34％），恶心（30％）是在补偿患者最常见的不良事件，而厌食（100％），乏力（59％），中性粒细胞减少（53 ％），血小板减少（50％）是最常见的失代偿期患者。结论：抗- HCV治疗肝硬化患者低于非肝硬化患者有效。消灭病毒减少了肝脏并发症和noncirrhotics改善生存的风险。基于数据的有效性和耐受性，治疗有代偿性肝硬化患者中效果显着，而失代偿期患者需要权衡风险与治疗的好处。
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雪泥1111

学习了。。。