Respuesta viral sostenida en los pacientes portadores de hepatitis C crónica que fueron sometidos al tratamiento con antivirales de acción directa en los Hospitales San Juan de Dios, México y Calderón Guardia en los años 2017-2018
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La hepatitis C crónica era uno de los grandes retos de la hepatología pues las terapias antivirales disponibles hasta hace 4 años presentaban una serie de efectos adversos que hacían difícil su aplicación y con resultados clínicos subóptimos. Con el advenimiento de los antivirales de acción directa de segunda y tercera generación ha sido posible alcanzar una ‘’curación virológica’’ definida por la respuesta viral sostenida de manera más eficaz y segura. Justificación: Costa Rica es un país con un sistema de salud pública que ha permitido la captación de una gran cantidad de estos pacientes y tratarlos con antivirales de acción directa de última generación. No se han publicado estudios epidemiológicos de estos pacientes ni clínicos que evalúen la respuesta de la población costarricense a estos fármacos. Materiales y Métodos: Se solicitó una lista a las jefaturas de los servicios de Gastroenterología de los hospitales San Juan de Dios, México y Calderón Guardia de los pacientes que fueron tratados con antivirales de acción directa contra hepatitis C en los años 2017 y 2018. Se documentaron datos epidemiológicos, clínicos, analíticos, virológicos, ultrasonográficos y endoscópicos de los pacientes sometidos al tratamiento y se compararon los resultados al inicio con el final del tratamiento. Resultados: 139 pacientes fueron reclutados, 3 de ellos fallecieron durante los trámites de inicio de la terapia, 19 no cumplieron los criterios de inclusión pues no se contó con la información suficiente acerca del uso del tratamiento. El análisis fue realizado con 117 pacientes entre los 3 hospitales, con un total de 101, cuya carga viral fue documentable para determinar una respuesta viral sostenida. La mayoría de los pacientes tratados fueron costarricenses nacidos entre 1945-1965, cuyos factores de riesgo para infección por hepatitis C no fueron detectados en la mayoría de los casos, con un predominio de genotipo...
Inglés: Chronic hepatitis C was one of the biggest challenges in hepatology because of few antiviral therapies available which until 4 years ago presented with a series of adverse effects that hinder their use with suboptimal clinical results. With the emergence of second and third generation direct acting antivirals it has been possible to achieve an effective and safe ‘’virologic cure’’ defined by sustained viral response. Justification: Costa Rica is a country with public healthcare system that made possible the detection of a number of these patients and treat them with last generation direct acting antivirals. Nonetheless, there has not been any published epidemiologic studies nor any clinical studies yet that evaluate the response of the costa rican population to these drugs. Materials and Methods: A list containing all the patients who used direct acting antivirals during 2017-2018 was solicited to the Gastroenterology Departments of the San Juan de Dios, México and Calderón Guardia hospitals. The epidemiological, clinical, laboratory, viral, ultrasonographic and endoscopic data of the patients who were treated was collected and the pre- and post- intervention results were compared. Results: 139 patients were recruited, 3 passed away during the beggining of therapy, 19 were excluded because they did not fill the inclusion criteria and did not have enough information about the therapy they used in their records. The analysis was made with 117 patients between the 3 hospitals, with a total of 101 whose hepatitis C RNA levels were documented in their records for the determination of their sustained viral response. The majority of patients were costa ricans born between 1945-1965, whose risk factors for hepatitis C infection were not detected in their medical records, with a non-cirrhotic, genotype 1b infections. The all-around sustained viral response was 98% without any significative differences between the different used therapies. There was not...
Inglés: Chronic hepatitis C was one of the biggest challenges in hepatology because of few antiviral therapies available which until 4 years ago presented with a series of adverse effects that hinder their use with suboptimal clinical results. With the emergence of second and third generation direct acting antivirals it has been possible to achieve an effective and safe ‘’virologic cure’’ defined by sustained viral response. Justification: Costa Rica is a country with public healthcare system that made possible the detection of a number of these patients and treat them with last generation direct acting antivirals. Nonetheless, there has not been any published epidemiologic studies nor any clinical studies yet that evaluate the response of the costa rican population to these drugs. Materials and Methods: A list containing all the patients who used direct acting antivirals during 2017-2018 was solicited to the Gastroenterology Departments of the San Juan de Dios, México and Calderón Guardia hospitals. The epidemiological, clinical, laboratory, viral, ultrasonographic and endoscopic data of the patients who were treated was collected and the pre- and post- intervention results were compared. Results: 139 patients were recruited, 3 passed away during the beggining of therapy, 19 were excluded because they did not fill the inclusion criteria and did not have enough information about the therapy they used in their records. The analysis was made with 117 patients between the 3 hospitals, with a total of 101 whose hepatitis C RNA levels were documented in their records for the determination of their sustained viral response. The majority of patients were costa ricans born between 1945-1965, whose risk factors for hepatitis C infection were not detected in their medical records, with a non-cirrhotic, genotype 1b infections. The all-around sustained viral response was 98% without any significative differences between the different used therapies. There was not...
Descripción
Tesis (especialista en gastroenterología y endoscopía digestiva)--Universidada de Costa Rica. Sistema de Estudios de Posgrado, 2019
Palabras clave
AGENTES ANTIVIRALES - USO TERAPÉUTICO - COSTA RICA, HEPATITIS C - TRATAMIENTO - COSTA RICA, HEPATITIS CRÓNICA - TRATAMIENTO - COSTA RICA, Hospital Dr. Rafael Angel Calderón Guardia (Costa Rica) - CASOS, HISTORIAS CLINICAS, ESTADISTICAS, ETC, Hospital México (Costa Rica) - CASOS, HISTORIAS CLINICAS, ESTADISTICAS, ETC., Hospital San Juan de Dios (Costa Rica) - CASOS, HISTORIAS CLÍNICAS, ESTADISTICAS, ETC.