Hepatit C Tanılı Hastaya Yaklaşım
Özet
Hepatit C virüsü başlıca kan yolu ile bulaşmakta olup, tedavi edilmez ise kronik karaciğer hastalığına neden olmakta, siroz ve hepatosellüler kansere kadar ilerleyen süreçlere yol açmaktadır. HCV’nin 6 ana genotipi vardır. Günümüzde pangenotik direk etkili antivirallerin tedavide kullanıma girmesiyle genotip tayini ihtiyacı ortadan kalkmıştır. Ayrıca tedavide pangenotipik bu ajanlar sayesinde tama yakın kalıcı viral yanıt sağlanmış, yüzde yüze yakın oranlarda kür elde edilmiştir. Uluslararası rehberlerde basitleştirilmiş pangenotipik tedavi algoritmaları düzenlenmiştir. Tedavi naif, tedavi deneyimli ve sirotik olup olmama durumuna göre 8 ile 12 hafta arasında tedavi süreleri belirtilmiştir. Pangenotipik ajanlar başlıca Glekaprevir/ Pibrentasvir ve Sofosbuvir/Velpatasvir’dir. Tedavi süresi tamamlandıktan sonra 12.hafta ve 24. hafta kalıcı virolojik yanıt açısından değerlendirilmelidir. Hepatit C’den korunmak için temel yol enfekte kan ve kan ürünlerine temasın azaltılmasıdır. Hepatit C virüsünün eliminasyonu hastalığın farkındalığının artırılması, tarama oranlarının artırılması ve tedavi için antivirallere erişiminin sağlanmasıyla mümkün olacaktır.
The hepatitis C virus is mainly transmitted via the blood and, if left untreated, causes chronic liver disease, progressing to cirrhosis and hepatocellular carcinoma. HCV has 6 main genotypes. Today, with the introduction of pan-genotypic direct-acting antivirals into treatment, the need for genotype determination has disappeared. In addition, the use of pangenotypic agents in treatment has resulted in almost complete and sustained viral responses, with cure rates approaching 100%. Simplified pangenotypic treatment algorithms have been published in international guidelines. Treatment durations between 8 and 12 weeks are specified according to treatment-naive, treatment-experienced and cirrhotic status. Pangenotypic agents are mainly glecaprevir/pibrentasvir and sofosbuvir/velpatasvir. At the end of treatment, patients should be monitored for sustained virologic response at 12 and 24 weeks. The main way to prevent hepatitis C is to reduce exposure to infected blood and blood products. Elimination of the hepatitis C virus will be possible by increasing awareness of the disease, increasing screening rates and providing access to antiviral treatment.
Referanslar
Naggie S, Wyles DL. Hepatitis C. In: Bennet JE, Dolin R, Blaser MJ (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 9th ed. Canada, Elsevier, 2020: 2040–71.
Tabak F. Hepatit C Virüsü. In: Topçu AW, Söyletir G, Doğanay M (eds). Enfeksiyon Hastalıkları ve Mikrobiyolojisi, 4th ed. İstanbul: Nobel Tıp Kitabevleri; 2017. p. 1694–1698.
Choo QL, Richman KH, Han JH, et al. Genetic organization and diversity of the hepatitis C virüs. Proceedings of the National Academy of Sciences of the United States of America. 1991;88(6):2451-5
Shimizu YK, Feinstone SM, Kohara M, et al. Hepatitis C virüs: detection of intracellular virüs particles by electron microscopy. Hepatology. 1996;23:205–209.
WHO Fact Sheet. Hepatitis C. Updated June 24, 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (Accesed: 25th January 2023)
Güner R, Tabak F. Viral Hepatit 2018. 1.baskı. İstanbul: İstanbul Tıp Kitabevleri; 2018.
Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating Prevalence of Hepatitis C Virüs Infection in the United States, 2013-2016. Hepatology 2019; 69:1020.
Onofrey S, Aneja J, Haney GA, et al. Underascertainment of acute hepatitis C virüs infections in the U.S. surveillance system: a case series and chart review. Annals of Internal Medicine 2015; 163:254.
Zibbell JE, Iqbal K, Patel RC, et al. Increases in hepatitis C virüs infection related to injection drug use among persons aged ≤30 years - Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012. Morbidity and Mortality Weekly Report 2015; 64:453.
Messina JP, Humphreys I, Flaxman A, et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology. 2015;61(1):77-87
Robaeys G, Bielen R, Azar DG, et al. Global genotype distribution of hepatitis C viral infection among people who inject drugs. Journal of Hepatology. 2016;65(6):1094-1103.
Mosley JW, Operskalski EA, Tobler LH, et al. Viral and host factors in early hepatitis C virüs infection. Hepatology. 2005;42:86–92.
Wang TY, Kuo HT, Chen LC, et al. Use of polymerase chain reaction for early detection and management of hepatitis C virüs infection after needlestick injury. Annals of Clinical & Laboratory Science 2002;32(2):137-41.
Hoofnagle JH. Hepatitis C: the clinical spectrum of disease. Hepatology. 1997;26(3 Suppl 1):15S-20S.
Thein HH, Yi Q, Dore GJ, et al. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virüs infection: a meta-analysis and meta-regression. Hepatology. 2008;48:418–431
Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127:S35–S50.
Cucchetti A, D'Amico G, Trevisani F, et al. Effect of direct-acting antivirals on future occurrence of hepatocellular carcinoma in compensated cirrhotic patients. Digestive and Liver Disease. 2018;50(2):156-162. doi:10.1016/j.dld.2017.10.004
Shivkumar S, Peeling R, Jafari Y, et al. Accuracy of rapid and point-of-care screening tests for hepatitis C: A systematic review and meta-analysis. Annals of Internal Medicine. 2012;157:558–566
European AIDS Treatment Network (NetwEAT) Acute Hepatitis C Infection Consensus Panel. Acute hepatitis C in HIV-infected individuals: recommendations from the European AIDS Treatment Network (NEAT) consensus conference. AIDS London England. 2011;25:399–409
Chou R, Wasson N. Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virüs infection: a systematic review. Annals of Internal Medicine. 2013;158:807–820.
Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38:518
Robic MA, Procopet B, Métivier S, et al. Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study. Journal of Hepatology. 2011;55(5):1017-24
World Health Organization. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virüs infection. Geneva: World Health Organization; 2018
European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C: Final update of the series. Journal of Hepatology. 2020 Nov;73(5):1170-1218
American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Available from: https://www.hcvguidelines.org (Accessed 24th Oct 2022).
Kinchen VJ, Cox AL, Bailey JR. Can Broadly Neutralizing Monoclonal Antibodies Lead to a Hepatitis C Virüs Vaccine? Trends in Microbiology. 2018;26(10):854-864.
Referanslar
Naggie S, Wyles DL. Hepatitis C. In: Bennet JE, Dolin R, Blaser MJ (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 9th ed. Canada, Elsevier, 2020: 2040–71.
Tabak F. Hepatit C Virüsü. In: Topçu AW, Söyletir G, Doğanay M (eds). Enfeksiyon Hastalıkları ve Mikrobiyolojisi, 4th ed. İstanbul: Nobel Tıp Kitabevleri; 2017. p. 1694–1698.
Choo QL, Richman KH, Han JH, et al. Genetic organization and diversity of the hepatitis C virüs. Proceedings of the National Academy of Sciences of the United States of America. 1991;88(6):2451-5
Shimizu YK, Feinstone SM, Kohara M, et al. Hepatitis C virüs: detection of intracellular virüs particles by electron microscopy. Hepatology. 1996;23:205–209.
WHO Fact Sheet. Hepatitis C. Updated June 24, 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (Accesed: 25th January 2023)
Güner R, Tabak F. Viral Hepatit 2018. 1.baskı. İstanbul: İstanbul Tıp Kitabevleri; 2018.
Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating Prevalence of Hepatitis C Virüs Infection in the United States, 2013-2016. Hepatology 2019; 69:1020.
Onofrey S, Aneja J, Haney GA, et al. Underascertainment of acute hepatitis C virüs infections in the U.S. surveillance system: a case series and chart review. Annals of Internal Medicine 2015; 163:254.
Zibbell JE, Iqbal K, Patel RC, et al. Increases in hepatitis C virüs infection related to injection drug use among persons aged ≤30 years - Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012. Morbidity and Mortality Weekly Report 2015; 64:453.
Messina JP, Humphreys I, Flaxman A, et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology. 2015;61(1):77-87
Robaeys G, Bielen R, Azar DG, et al. Global genotype distribution of hepatitis C viral infection among people who inject drugs. Journal of Hepatology. 2016;65(6):1094-1103.
Mosley JW, Operskalski EA, Tobler LH, et al. Viral and host factors in early hepatitis C virüs infection. Hepatology. 2005;42:86–92.
Wang TY, Kuo HT, Chen LC, et al. Use of polymerase chain reaction for early detection and management of hepatitis C virüs infection after needlestick injury. Annals of Clinical & Laboratory Science 2002;32(2):137-41.
Hoofnagle JH. Hepatitis C: the clinical spectrum of disease. Hepatology. 1997;26(3 Suppl 1):15S-20S.
Thein HH, Yi Q, Dore GJ, et al. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virüs infection: a meta-analysis and meta-regression. Hepatology. 2008;48:418–431
Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127:S35–S50.
Cucchetti A, D'Amico G, Trevisani F, et al. Effect of direct-acting antivirals on future occurrence of hepatocellular carcinoma in compensated cirrhotic patients. Digestive and Liver Disease. 2018;50(2):156-162. doi:10.1016/j.dld.2017.10.004
Shivkumar S, Peeling R, Jafari Y, et al. Accuracy of rapid and point-of-care screening tests for hepatitis C: A systematic review and meta-analysis. Annals of Internal Medicine. 2012;157:558–566
European AIDS Treatment Network (NetwEAT) Acute Hepatitis C Infection Consensus Panel. Acute hepatitis C in HIV-infected individuals: recommendations from the European AIDS Treatment Network (NEAT) consensus conference. AIDS London England. 2011;25:399–409
Chou R, Wasson N. Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virüs infection: a systematic review. Annals of Internal Medicine. 2013;158:807–820.
Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38:518
Robic MA, Procopet B, Métivier S, et al. Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study. Journal of Hepatology. 2011;55(5):1017-24
World Health Organization. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virüs infection. Geneva: World Health Organization; 2018
European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C: Final update of the series. Journal of Hepatology. 2020 Nov;73(5):1170-1218
American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Available from: https://www.hcvguidelines.org (Accessed 24th Oct 2022).
Kinchen VJ, Cox AL, Bailey JR. Can Broadly Neutralizing Monoclonal Antibodies Lead to a Hepatitis C Virüs Vaccine? Trends in Microbiology. 2018;26(10):854-864.
