Page 41 - The Flying Publisher Guide to Hepatitis C Treatment
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Patients’ monitoring during and after treatment | 41
jaundice). Assumed SVR rate is <7% in HCV G1 and <40% in
non-G1 infected patients.
The progression of fibrosis and other HCV-associated
histopathologic changes may also be related to coagulation-
cascade activity and hepatic accumulation of iron, which have
been associated with mutations in factor V and
hemochromatosis genes, respectively.
The HIV-HCV coinfection is a particularly challenging situation.
The severity of liver disease must be routinely assessed in these
patients in order to initiate treatment before progression of liver
disease. An important number of coinfected patients are referred
to hepatology clinics only when they have hepatic
decompensation, at which time the HCV treatment options are
limited.
Drug-induced liver injuries (DILI) following antiretroviral
therapy pose significant problems in HIV/HCV co-infection,
especially in persons with advanced liver disease and cirrhosis.
Dose modifications or even avoidance of liver-metabolized
antiretroviral drugs may be required in patients with CP class B
and C disease. Overall, in the absence of clinically significant
fibrosis, it seems worthwhile to defer treatment. However, it is
equally important to apply the results of the clinical studies on a
case by case basis, weighing the treatment response rate and the
long-term outcomes.
Outlook
Nucleic acid testing, genotyping and assessment of the level of
hepatic fibrosis are invaluable tools in the diagnosis of HCV
infection, treatment guidance and monitoring.
Although LB is still considered the gold standard for the
progression of hepatic fibrosis in chronic hepatitis C, a series of
non-invasive radiological and serum-based markers are being
investigated for their diagnostic accuracy. New real-time PCR
tests are faster and more cost-effective methods for the