Search results for " antiviral"
showing 10 items of 133 documents
[Access to hepatitis C treatment: a lesson for the future.]
2018
L’immissione in commercio dei farmaci antivirali ad azione diretta (DAA) di nuova generazione per la terapia dell’infezione cronica da virus dell’epatite C ha rivoluzionato lo scenario precedente e ha messo a dura prova le istituzioni, a causa del prezzo elevato delle terapie. Un’analisi di quanto accaduto negli ultimi tre anni, specialmente in Italia, ci aiuta a comprendere come è stata gestita la contrattazione dei prezzi e soprattutto con quali criteri si è scelto, in una prima fase, di consentire un accesso ristretto in base al bisogno di cura dei pazienti. Ciò consente di mettere a fuoco alcuni temi importanti e di individuare le sfide che ci attendono nel prossimo futuro. The new gene…
EFFETTI DELLA TERAPIA CON DIRECT ACTING ANTIVIRALS (DAAS) SUI PARAMETRI ECOGRAFICI DI IPERTENSIONE PORTALE
2017
Obiettivi dello studio: Tra gli end point della terapia antivirale con DAAs nella cirrosi HCV (LCHCV) oltre all' eradicazione del virus vi sono: la regressione della fibrosi e dell’ipertensione portale. Abbiamo valutato in pazienti LCHCV e risposta sostenuta (SVR) alla terapia con DAAs il comportamento dell’AST to Platelet Ratio Index (APRI) (marker indiretto di fibrosi) e di due segni ecografici di ipertensione portale: calibro della vena porta (cVP) e diametro longitudinale della milza (DLM). Materiali: 98 pazienti con LCHCV,al Baseline (BL) a fine terapia (FT) e tre mesi (PostT3) e 9 mesi dopo la fine della terapia (PostT9) eseguivano i test di funzionalità epatica e la conta piastrinica…
Effects of direct-acting antiviral therapy (DAAS) on the ultrasound parameters of portal hypertension
2018
Background:Among the endpoints of antiviral therapy with DAAs in HCV related liver cirrhosis (LC-HCV) in addition to the eradication of the virus there are the regression of fibrosis and of portal hypertension. For this reason we evaluated in LC-HCV patients and sustained virological response (SVR) to DAAs therapy the behavior of the AST to Platelet Ratio Index (APRI) (indirect marker of fibrosis) and of two ultrasound (US) signs of portal hypertension: caliber of the portal vein (cPV ) and longitudinal diameter of the spleen (LDS) Methods:132 patients with LC-HCV at baseline (BL), at three months (PostT3) and 12 months (PostT12) after the end of therapy, performed liver function tests and …
Profiling the risk of hepatocellular carcinoma after long-term HCV eradication in patients with liver cirrhosis in the PITER cohort
2023
Background and aims: Severe liver disease markers assessed before HCV eradication are acknowledged to usually improve after the SVR. We prospectively evaluated, in the PITER cohort, the long-term HCC risk profile based on predictors monitored after HCV eradication by direct-acting antivirals in patients with cirrhosis. Methods: HCC occurrence was evaluated by Kaplan-Meier analysis. Cox regression analysis identified the post-treatment variables associated with de-novo HCC; their predictive power was presented in a nomogram. Results: After the end of therapy (median follow-up:28.47 months), among 2064 SVR patients, 119 (5.8%) developed de-novo HCC. The HCC incidence was 1.90%, 4.21%, 6.47% a…
Incidence of DAA failure and the clinical impact of retreatment in real-life patients treated in the advanced stage of liver disease: Interim evaluat…
2017
Background: Few data are available on the virological and clinical outcomes of advanced liver disease patients retreated after first-line DAA failure. Aim: To evaluate DAA failure incidence and the retreatment clinical impact in patients treated in the advanced liver disease stage. Methods: Data on HCV genotype, liver disease severity, and first and second line DAA regimens were prospectively collected in consecutive patients who reached the 12-week post-treatment and retreatment evaluations from January 2015 to December 2016 in 23 of the PITER network centers. Results: Among 3,830 patients with advanced fibrosis (F3) or cirrhosis, 139 (3.6%) failed to achieve SVR. Genotype 3, bilirubin lev…
Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: A European study
2016
Background & Aims: All oral direct acting antivirals (DAA) have been shown to improve the liver function of patients with decompensated cirrhosis but it is presently unknown whether this clinical improvement may lead to the delisting of some patients. The aim of this study was to assess if and which patients can be first inactivated due to clinically improvement and subsequently delisted in a real life setting. Methods: 103 consecutive listed patients without hepatocellular carcinoma were treated with different DAA combinations in 11 European centres between February 2014 and February 2015. Results: The cumulative incidence of inactivated and delisted patients by competing risk analysis…
Phylogenetic analysis in the clinical risk management of an outbreak of hepatitis C virus infection among transfused thalassaemia patients in Italy
2021
Background: Occurrence of hepatitis C virus (HCV) infection is reduced by effective risk management procedures, but patient-to-patient transmission continues to be reported in healthcare settings. Aim: To report the use of phylogenetic analysis in the clinical risk management of an HCV outbreak among 128 thalassaemia outpatients followed at a thalassaemia centre of an Italian hospital. Methods: Epidemiological investigation and root-cause analysis were performed. All patients with acute hepatitis and known chronic infection were tested for HCV RNA, HCV genotyping, and NS3, NS5A, and NS5B HCV genomic region sequencing. To identify transmission clusters, phylogenetic trees were built for each…
Management of HCV-Related Liver Disease in Hemophilia and Thalassemia
2018
AbstractChronic infection with the hepatitis C virus (HCV) has long been the dominant complication of substitution therapy in patients with inherited blood disorders and the cause of anticipated death due to end-stage liver disease. In hemophilia, transmission of HCV with clotting factors concentrates started to be curbed in the mid-1980s following the adoption of procedures of virus inactivation of concentrates based on heat, whereas in the 1990s treatment of HCV infection with interferon monotherapy was attempted, however, with little success. The advent of combination therapy of interferon with ribavirin led to a substantial improvement of treatment outcome (40% rate of cure), that howev…
Boceprevir is highly effective in treatment-experienced hepatitis C virus-positive genotype-1 menopausal women
2014
AIM: To investigate the safety/efficacy of Boceprevirbased triple therapy in hepatitis C virus (HCV)-G1 menopausal women who were historic relapsers, partial-responders and null-responders. METHODS: In this single-assignment, unblinded study, we treated fifty-six menopausal women with HCV-G1, 46% F3-F4, and previous PEG-α/RBV failure (7% null, 41% non-responder, and 52% relapser) with 4 wk lead-in with PEG-IFNα2b/RBV followed by PEGIFNα2b/RBV+Boceprevir for 32 wk, with an additional 12 wk of PEG-IFN-α-2b/RBV if patients were HCV-RNA-positive by week 8. In previous null-responders, 44 wk of triple therapy was used. The primary objective of retreatment was to verify whether a sustained virolo…