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Decade of optimizing therapy with direct-acting antiviral drugs and the changing profile of patients with chronic hepatitis C

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World Journal of Gastroenterology 2023年第6期29卷 949-966页

作者： MichałBrzdęk Dorota Zarębska-Michaluk Federica Invernizzi Marta Cilla krystyna dobrowolska Robert Flisiak Collegium Medicum Jan Kochanowski UniversityKielce 25-516Poland of Infectious Diseases Jan Kochanowski UniversityKielce 25-516Poland Center for Liver Disease Division of Internal Medicine and HepatologyIRCCS Ospedale San RaffaeleMilan 20-132Italy Department of Infectious Diseases and Hepatology Medical University of BiałystokBiałystok 15-540Poland

Chronic infection with the hepatitis C virus(HCV)remains a major health problem affecting approximately 58 million people *** the era of interferon(IFN)-based regimens,patients particularly infected with genotypes 1 and 4 achieved a low response *** implementation of direct-acting antivirals changed the landscape of HCV *** increase in effectiveness provided us with the hope of eliminating HCV as a significant public threat by *** the following years,there was an observed improvement in the treatment of HCV with genotype-specific regimens and highly effective pangenotypic options that are the most recent stage of the *** optimization of therapy was accompanied by changes in the patient profile from the beginning of the IFN-free era over *** treated with antiviral therapies were younger in successive periods,less burdened with comorbidities and comedications,more frequently treatment-naïve and had less advanced liver *** the IFN-free era,specific subpopulations such as patients with HCV/HIV coinfection,those with a history of previous treatment,patients with renal impairment or with cirrhosis had lower chances for a virologic ***,these populations should no longer be considered difficult to *** the high effectiveness of HCV therapy,there is a small percentage of patients with treatment ***,they can be effectively retreated with pangenotypic rescue regimens.

关键词： Hepatitis C virus Interferon Direct-acting antiviral Epidemiology Chronic hepatitis C

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Real-world effectiveness and safety of direct-acting antivirals in hepatitis C virus patients with mental disorders

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World Journal of Gastroenterology 2023年第25期29卷 4085-4098页

作者： Dorota Dybowska Dorota Zarebska-Michaluk Piotr Rzymski Hanna Berak Beata Lorenc Marek Sitko Michal Dybowski Wlodzimierz Mazur Magdalena Tudrujek-Zdunek Justyna Janocha-Litwin Ewa Janczewska Jakub Klapaczynski Anna Parfieniuk-Kowerda Anna Piekarska Barbara Sobala-Szczygiel krystyna dobrowolska Malgorzata Pawlowska Robert Flisiak Department of Infectious Diseases and Hepatology Faculty of MedicineNicolaus Copernicus UniversityBydgoszcz 85-030Poland Department of Infectious Diseases and Allergology Jan Kochanowski UniversityKielce 25-317Poland Department of Infectious Diseases Provincial HospitalKielce 25-317Poland Department of Environmental Medicine University of Medical SciencesPoznań60-806Poland Integrated Science Association Universal Scientific Education and Research NetworkPoznań60-806Poland Outpatient Clinic Hospital for Infectious Diseases in WarsawWarsaw 01-201Poland Pomeranian Center of Infectious Diseases Medical UniversityGdańsk 80-214Poland Department of Infectious and Tropical Diseases Jagiellonian UniversityKraków 31-088Poland Utrecht University School of Economics Utrecht UniversityUtrecht 3584 ECNetherlands Clinical Department of Infectious Diseases Medical University of SilesiaChorzów 41-500Poland Department of Infectious Diseases Medical University of LublinLublin 20-059Poland Department of Infectious Diseases and Hepatology Medical University of WrocławWrocław 50-367Poland Department of Basic Medical Sciences Faculty of Public Health in BytomMedical University of SilesiaKatowice 40-007Poland Department of Internal Medicine and Hepatology Central Clinical Hospital of the Ministry of Internal Affairs and AdministrationWarsaw 00-241Poland Department of Infectious Diseases and Hepatology Medical University of BiałystokBiałystok 15-089Poland Department of Infectious Diseases and Hepatology Medical University ofŁódźŁódź91-347Poland Department of Infectious Diseases and Hepatology Medical University of SilesiaBytom 41-902Poland Collegium Medicum Jan Kochanowski UniversityKielce 25-317Poland

BACKGROUND It is estimated that 58 million people worldwide are infected with the hepatitis C virus(HCV).Patients with severe psychiatric disorders could not be treated with previously available interferon-based therapies due to their unfavorable side effect *** has changed with the introduction of direct-acting antivirals(DAA),although their real-life tolerance and effectiveness in patients with different psychiatric disorders remain to be *** To evaluate the effectiveness and safety of DAA in patients with various mental *** This was a retrospective observational study encompassing 14272 patients treated with DAA for chronic hepatitis C in 22 Polish hepatology centers,including 942 individuals diagnosed with a mental disorder(anxiety disorder,bipolar affective disorder,depression,anxiety-depressive disorder,personality disorder,schizophrenia,sleep disorder,substance abuse disorder,and mental illness without a specific diagnosis).The safety and effectiveness of DAA in this group were compared to those in a group without psychiatric illness(n=13330).Antiviral therapy was considered successful if serum ribonucleic acid(RNA)of HCV was undetectable 12 wk after its completion[sustained virologic response(SVR)].Safety data,including the incidence of adverse events(AEs),serious AEs(SAEs),and deaths,and the frequency of treatment modification and discontinuation,were collected during therapy and up to 12 wk after treatment *** entire study population was included in the intent-to-treat(ITT)***-protocol(PP)analysis concerned patients who underwent HCV RNA evaluation 12 wk after completing *** Among patients with mental illness,there was a significantly higher percentage of men,treatmentnaive patients,obese,human immunodeficiency virus and hepatitis B virus-coinfected,patients with cirrhosis,and those infected with genotype 3(GT3)while infection with GT1b was more frequent in the population without psychia

关键词： Hepatitis C Mental disorders Direct-acting antivirals

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