A C-vírus hepatitis diagnosztikája, antivirális kezelése, kezelés utáni gondozása. Magyar konszenzusajánlás

B. Hunyady, Judit Gervain, Gábor Horváth, Mihály Makara, A. Pár, F. Szalay, L. Telegdy, István Tornai

Research output: Article

8 Citations (Scopus)

Abstract

Approximately 70 000 people are infected with hepatitis C virus in Hungary, more than half of whom are not aware of their infection. Early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases (liver cirrhosis and liver cancer) and its complications. In addition, it may increase work productivity and life expectancy of infected individual, and can prevent further viral transmission. Early recognition can substantially reduce the long term financial burden of related morbidity from socioeconomic point of view. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can kill the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of two direct acting first generation protease inhibitor drugs (boceprevir and telaprevir) to the dual therapy increased the chance of sustained clearance of virus to 63-75% and 59-66%, respectively. These two protease inhibitor drugs are available and financed for a segment of Hungarian patients since May 2013. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. For initiation of treatment as well as for on-treatment decisions accurate and timely molecular biology tests are mandatory. Staging of liver damage (fibrosis) non-invasive methods (transient elastography and biochemical methods) are acceptable to avoid concerns of patients related to liver biopsy. Professional decision for treatment is balanced against budget limitations in Hungary, and priority is given to those with urgent need using a national Priority Index system reflecting stage of liver disease as well as additional factors (activity and progression of liver disease, predictive factors and other special circumstances). All naïve patients are given a first chance with dual therapy. Those with genotype 1 infection and with on-treatment or historic failure to dual therapy are eligible to receive protease inhibitor based triple therapy provided, they reach financial cutoff eligibility based on Priority Index. Duration of therapy is usually 48 weeks in genotype 1 with a response-guided potential to reduce duration for non-cirrhotic patients. Patients with non-1 genotypes are treated with dual therapy (without protease inhibitors) for a genotype and response driven duration of 16, 24, 48, or 72 week. Careful monitoring for early recognition and management of side-effects as well as viral response and potential breakthrough during protease-inhibitor therapy are recommended. Orv. Hetil., 2014, 155(Szuppl. 2), 3-24.

Original languageHungarian
Pages (from-to)3-24
Number of pages22
JournalOrvosi Hetilap
Volume155
Issue numberSUPPL. 2
DOIs
Publication statusPublished - 2014

Fingerprint

Hepacivirus
Liver Diseases
Guidelines
Protease Inhibitors
Therapeutics
Hungary
Genotype
Liver Cirrhosis
Liver
Pharmaceutical Preparations
Viruses
Elasticity Imaging Techniques
Ribavirin
Wounds and Injuries
Budgets
Liver Neoplasms
Life Expectancy
Infection
Treatment Failure
Interferons

Keywords

  • boceprevir
  • directly acting antiviral drug
  • hepatitis C virus
  • interferon
  • liver carcinoma
  • liver cirrhosis
  • pegylated interferon
  • protease inhibitor
  • ribavirin
  • telaprevir
  • viral hepatitis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A C-vírus hepatitis diagnosztikája, antivirális kezelése, kezelés utáni gondozása. Magyar konszenzusajánlás. / Hunyady, B.; Gervain, Judit; Horváth, Gábor; Makara, Mihály; Pár, A.; Szalay, F.; Telegdy, L.; Tornai, István.

In: Orvosi Hetilap, Vol. 155, No. SUPPL. 2, 2014, p. 3-24.

Research output: Article

Hunyady, B. ; Gervain, Judit ; Horváth, Gábor ; Makara, Mihály ; Pár, A. ; Szalay, F. ; Telegdy, L. ; Tornai, István. / A C-vírus hepatitis diagnosztikája, antivirális kezelése, kezelés utáni gondozása. Magyar konszenzusajánlás. In: Orvosi Hetilap. 2014 ; Vol. 155, No. SUPPL. 2. pp. 3-24.
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abstract = "Approximately 70 000 people are infected with hepatitis C virus in Hungary, more than half of whom are not aware of their infection. Early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases (liver cirrhosis and liver cancer) and its complications. In addition, it may increase work productivity and life expectancy of infected individual, and can prevent further viral transmission. Early recognition can substantially reduce the long term financial burden of related morbidity from socioeconomic point of view. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can kill the virus in 40-45{\%} of previously not treated (na{\"i}ve), and in 5-21{\%} of previous treatment-failure patients. Addition of two direct acting first generation protease inhibitor drugs (boceprevir and telaprevir) to the dual therapy increased the chance of sustained clearance of virus to 63-75{\%} and 59-66{\%}, respectively. These two protease inhibitor drugs are available and financed for a segment of Hungarian patients since May 2013. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. For initiation of treatment as well as for on-treatment decisions accurate and timely molecular biology tests are mandatory. Staging of liver damage (fibrosis) non-invasive methods (transient elastography and biochemical methods) are acceptable to avoid concerns of patients related to liver biopsy. Professional decision for treatment is balanced against budget limitations in Hungary, and priority is given to those with urgent need using a national Priority Index system reflecting stage of liver disease as well as additional factors (activity and progression of liver disease, predictive factors and other special circumstances). All na{\"i}ve patients are given a first chance with dual therapy. Those with genotype 1 infection and with on-treatment or historic failure to dual therapy are eligible to receive protease inhibitor based triple therapy provided, they reach financial cutoff eligibility based on Priority Index. Duration of therapy is usually 48 weeks in genotype 1 with a response-guided potential to reduce duration for non-cirrhotic patients. Patients with non-1 genotypes are treated with dual therapy (without protease inhibitors) for a genotype and response driven duration of 16, 24, 48, or 72 week. Careful monitoring for early recognition and management of side-effects as well as viral response and potential breakthrough during protease-inhibitor therapy are recommended. Orv. Hetil., 2014, 155(Szuppl. 2), 3-24.",
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