ANTIVIRAIS DE AÇÃO DIRETA NO TRATAMENTO DA HEPATITE C: FATORES ASSOCIADOS COM A RESPOSTA VIROLÓGICA
DOI:
https://doi.org/10.5902/2236583469186Keywords:
Hepatite C Crônica; Infecções; Resposta Viral Sustentada; Antivirais; Epidemiologia.Abstract
Objective: To analyze the factors associated with the sustained virologic response (SVR) in the direct-acting antivirals treatment in hepatitis C virus (HCV) patients. Method: Analytical cross-sectional study, from 2015 to 2019. For bivariate analysis Pearson's Chi-Square and Fisher's Exact tests were performed, adopting a value of p ≤ 0.05. Results: A total of 244 cases were analyzed, and a statistically significant association was found with SVR, the Sofosbuvir and Daclatasvir therapeutic scheme. Regarding the genotype (GT) type, GT1 presented high SVR, while GT3 had less response. There was no association between liver disease staging and viral load. Conclusion: Sofosbuvir and Daclatasvir was the only therapeutic scheme that showed a statistically significant association; GT1 had high SVR, while in GT 3 SVR was lower. There was no association between liver disease staging and viral load.
Downloads
References
Ministério da Saúde (BR). Ministério da Saúde atualiza PCDT de hepatite C. [Internet]. Brasília: Ministério da Saúde; 2019 [citado 15 Jun 2021]. Disponível em: http://www.blog.saude.gov.br/ index.php/ entenda-o-sus/53700-ministerio-da-saude-atualiza-pcdt-de-hepatite-c.
Ministério da Saúde (BR). Plano para eliminação da hepatite C no Brasil. [Internet]. Brasília: Ministério da Saúde; 2018 [citado 15 Jun 2021]. Disponível em: http://www.aids.gov.br/system/tdf/pub/2016/66284/plano_para_eliminacao_hepatite_c_no_brasil_170119.pdf?file=1&type=node&id=66284&force=1.
Brasil. Ministério da Saúde. Portaria n° 863, de 4 de novembro de 2002. Estabelece o Protocolo Clínico e Diretrizes Terapêuticas para o tratamento da Hepatite Viral Crônica C. [Internet]. 2002. [citado 16 Jun 2021]. Disponível em: http://www3.servicos.ms.gov.br/saude_externo/downloads/Portaria863HepatitesVirais.doc.
Brasil. Ministério da Saúde. Portaria nº 20, de 25 de julho de 2012. Torna pública a decisão de incorporar os inibidores de protease Telaprevir e Boceprevir para tratamento da hepatite crônica C no Sistema Único de Saúde (SUS). [Internet]. 2012. [citado 16 Jun 2021]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/sctie/2012/prt0020_25_07_2012.html.
Ministério da Saúde (BR). Relatório de recomendação da comissão nacional de incorporação de tecnologias no SUS: inibidores de protease (Boceprevir e Telaprevir) para o tratamento da hepatite crônica C. [Internet]. Brasília: Ministério da Saúde; 2016 [citado 5 Ago 2021]. Disponível em: http://conitec.gov.br/images/Relatorios/2016/Relatorio_Telaprevir_Boceprevir_Hepatite_Recomendacao.pdf.
Ministério da Saúde (BR). Protocolo clínico e diretrizes terapêuticas para hepatite C e coinfecções. [Internet]. Brasília: Ministério da Saúde; 2019 [citado 5 Ago 2021]. Disponível em: http://www.aids.gov.br/ system/tdf/pub/2017/64644/pcdt_hepatitec_07062018_final_web.pdf?file=1&type=node&id=64644&force=1.
Paik SW. Goals of treatment, indication, and treatment for chronic hepatitis C. Korean J Gastroenterol. 2008;51(6):368-371.
Sarwar S, Khan AA, Tarique S. Response guided interferon therapy for genotype 3 of chronic hepatitis C: compliance and outcome. Pak J Med Sci. 2015;31(4):843-847. doi: 10.12669/pjms.314.7293.
Leroy V, Angus P, Bronowicki J-P, Dore GJ, Hezode C, Pianko S, et al. Daclatasvir, sofosbuvir, and ribavirin for hepatitis C virus genotype 3 and advanced liver disease: a randomized phase III study (ALLY-3+). Hepatology. 2016;63(5):1430-1441. doi: 10.1002/hep.28473.
Hézode C, Lebray P, Ledinghen V, Zoulim F, Martino V, Boyer N, et al. Daclatasvir plus sofosbuvir, with or without ribavirin, for hepatitis C virus genotype 3 in a French early access programme. Liver Int. 2017;37(9):1314-1324. doi: 10.1111/liv.13383.
Smith D, Magri A, Bonsall D, Ip CLC, Trebes A, Brown A, et al. Resistance analysis of genotype 3 hepatitis C virus indicates subtypes inherently resistant to nonstructural protein 5A inhibitors. Hepatology. 2019;69(5):1861-1872. doi: https://doi.org/10.1002/hep.29837.
World Gastroenterology Organisation. Diagnóstico, tratamento e prevenção da hepatite C. [Internet]. [citado 20 Ago 2021]. Disponível em: https://www.worldgastroenterology.org/guidelines/global-guidelines/hepatitis-c/hepatitis-c-portuguese.
Ibm Corp. Released. IBM SPSS Statistics for Windows, version 20.0. Armonk (NY): IBM Corp.; 2011.
Compri AP, Silva VCM, Lemos MF, Oba IT, Moreira RC. Resposta virológica sustentada às drogas de ação direta de segunda geração para hepatite C. BEPA. 2020;196(17):1-10.
Lobato CMO, Codes L, Silva GF, Souza AFM, Coelho HSM, Pedroso MLA, et al. Direct antiviral therapy for treatment of hepatitis C: a real-world study from Brazil. Ann Hepatol. 2019;18(6):849-854. doi: https://doi.org/10.1016/j.aohep.2019.08.001.
Torres AD, Sparvoli JMH, Sparvoli AC, Gonçalves CV. Sustained virologic response rate in chronic hepatitis c patients through direct-acting antivirals therapy. Arq. Gastroenterol. 2019;56(4):394-398. doi: https://doi.org/10.1590/S0004-2803.201900000-79.
Rolim FE, Braga LLBC, Lima JMC, Mello FSF, Pinho CS, Hyppolito EB. Hepatite crônica pelo vírus C: avaliação da resposta virológica ao tratamento com os novos antivirais de ação direta. Rev Med UFC. 2018;58(4):8-12. doi: 10.20513/2447-6595.2018v58n4p8-12.
Bartolini B, Giombini E, Taibi C, Lionetti R, Montalbano M, Visco-Comandini U, et al. Characterization of naturally occurring NS5A and NS5B polymorphisms in patients infected with HCV genotype 3a treated with direct-acting antiviral agents. Viruses. 2017;9(8):212. doi: 10.3390/v9080212.
Brasil. Comissão Nacional de Incorporação de Tecnologias no SUS. Relatório de Recomendação: inibidores de protease (Boceprevir e Telaprevir) para o tratamento da hepatite crônica C. [Internet]. Brasília: Ministério da Saúde; 2012 [citado 20 Jan 2022]. Disponível em: http://conitec .gov.br/images/Relatorios/2012/Boceprevir_Telaprevir_final.pdf.
McEwan P, Webster S, Ward T, Brenner M, Kalsekar A, Yuan Y. Estimating the cost-effectiveness of daclatasvir + sofosbuvir versus sofosbuvir + ribavirin for patients with genotype 3 hepatitis C virus. Cost Eff Resour Alloc. 2017;15(1):15. doi: 10.1186/s12962-017-0077-4.
American Association for the Study of Liver Diseases. HCV resistance primes. [Internet]. [citado 10 Jan 2020]. Disponível em: https://www.hcvguidelines.org/evaluate/resistance.
Al Marzooqi SH, Feld JJ. Sorting out cirrhosis: mechanisms of non-response to hepatitis C therapy. Liver Int. 2015;35(8):1923-1933. doi: 10.1111/liv.12861.
Weiskirchen R, Weiskirchen S, Tacke F. Recent advances in understanding liver fibrosis: bridging basic science and individualized treatment concepts. F1000Res. 2018;7 (F1000 Faculty Rev):921. doi: 10.12688/f1000research.14841.1.
Pott-Junior H, Bricks G, Grandi G, Senise JF, Castelo Filho A. Sofosbuvir in combination with daclatasvir or simeprevir for 12 weeks in noncirrhotic subjects chronically infected with hepatitis C virus genotype 1: a randomized clinical trial. Clin Microbiol Infect. 2019;25(3):365-371. doi: https://doi.org/10.1016/j.cmi.2018.06.007.
Sulkowski MS, Vargas HE, Di Bisceglie AM, Kuo A, Reddy KR, Lim JK, et al. Effectiveness of simeprevir plus sofosbuvir, with or without ribavirin, in real-world patients with hcv genotype 1 infection. Gastroenterology. 2016;150(2):419-429. doi: 10.1053/j.gastro.2015.10.013.
Feld JJ, Maan R, Zeuzem S, Kuo A, Nelson DR, Di Bisceglie AM, et al. Effectiveness and safety of sofosbuvir-based regimens for chronic hcv genotype 3 infection: results of the HCV-TARGET study. Clin Infect Dis. 2016;63(6):776-783. doi: 10.1093/cid/ciw387.