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
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