Name: Ana Carolina D`Ettorres Coelho
Type: MSc dissertation
Publication date: 13/06/2018
Advisor:

Name	Role
David Jamil Hadad	Advisor *

Examining board:

Name	Role
David Jamil Hadad	Advisor *
Lauro Ferreira da Silva Pinto Neto	External Examiner *
Maria da Penha Zago Gomes	Internal Examiner *

Summary: INTRODUCTION: The development of molecular biology techniques and the best recognition of the viral replication cycle, there has been a major change in the treatment of hepatitis C virus (HCV). From this greater understanding of viral replication, new molecules, called direct acting antivirals (DAAs), were developed. The Brazilian Protocol for the Treatment of Hepatitis C and Co-infections, published in 2015, contemplated the use of DAAs (Sofosbuvir, Daclatasvir and Simeprevir) for a selected group of patients.
OBJECTIVE: To determine the efficacy achieved in the treatment of chronic HCV infection with, interferon-free, DAAs based therapies at the Infectious Diseases Service of the Hospital Universitário Cassiano Antônio Moraes (HUCAM).
PATIENTS AND METHODS: A retrospective observational study of patients with chronic hepatitis C in the treatment of DAA between June 2015 and December 2016. All data were obtained from the medical charts of the Hospital Universitário Cassiano Antônio Moraes (HUCAM).
RESULTS: A total of 107 patients with chronic HCV infection were analyzed. Eighty-nine patients (83.2%) were infected with genotype 1 at the start of treatment, 16 (14.9%) genotype 3 and two genotype 4 (1.9%). Forty-three patients (40.2%) had hepatic cirrhosis, 88.4% (38/43) classified as CHILD-PUGH A, and others as B. Thirty-one patients (29%) were coinfected with the virus HIV. Thirty-nine (36.4%) had previously been treated for HCV. Among the 107 patients, 87.9% (94/107) achieved a sustained virological response (SVR). Of the genotype 1 patients, 91% (81/89) achieved SVR; genotype 3, 68.7% (11/16); and genotype 4, 100% (2/2) (p 0.048). Genotype 3 presented greater virological failure (37.1%) when compared to the other genotypes (8.8%) (p 0.011). Among patients classified as; METAVIR F4, 92.7% achieved SVR; METAVIR F3, 84.4%; METAVIR F2, 88.9%; and METAVIR F1, 100% (p 0.420). Among patients exposed to previous treatments, 92.3% achieved SVR, while patients who were naive, 85.1% achieved SVR (p 0.363).
DISCUSSION AND CONCLUSION: The overall efficacy observed in this study, with SVR in 87.9% of cases, is in accordance with international studies that showed efficacy between 87% and 97%. When we observed subgroups, patients with cirrhosis presented 92.7% SVR, also consistent with results from previously published observational studies. In our study, a greater proportion of failure in genotype 3 (37.1%) was observed. Currently, patients with HCV genotype 3 infection present a greater challenge for cure compared to the others, since in addition to the smaller amount of active drugs available, they still have worse results when treated with current DAAs. The results obtained in the HUCAM infectious diseases service are in agreement with the data of national and international studies, corroborating with the excellent performance expected by therapies based on DAAs.
KEY WORDS: Hepatitis C; Sofosbuvir; Simeprevir; Daclatasvir.