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The Role of Direct-acting Antivirals in the Treatment of Children with Chronic Hepatitis C

Journal of Clinical and Translational Hepatology 2017年第1期5卷 59-66页

作者： Christine Hong Ting Yang Eric R.Yoo Aijaz Ahmed Division of Pediatric Gastroenterology Stanford University School of MedicineStanfordCAUSA Department of Medicine University of Illinois College of MedicineChicagoILUSA Division of Gastroenterology and Hepatology Stanford University School of MedicineStanfordCAUSA

In the United States,chronic infection with the hepatitis C virus(HCV)affects an estimated 0.1-2%of the pediatric population,who are consequently at risk for major complications,including cirrhosis,hepatocellular carcinoma,and *** current standard of treatment for chronic hepatitis C(CHC)in children is pegylated-interferon-alpha(PEG-IFN)in combination with ***-IFN/ribavirin therapy is approved for children ages 3 and older;however,it is often held from use until adulthood because of its extensive list of potential side effects and high likelihood of causing adverse *** CHC is usually indolent in children and adolescents,immediately treating and curbing the spread of HCV before adulthood is important,as there can be transmission to other individuals via sexual activity and infected females can later vertically transmit the infection during pregnancy,the latter representing the most common means of transmission for children in the United *** recent development of direct-acting antivirals has shown promising results in clinical trials for use in children and has dramatically increased the rates of sustained virological response in adults while improving side effect profiles as compared to interferonbased *** the usually indolent course of CHC in children,significant side effects of the currently-approved PEG-IFN/ribavirin therapy,and likely availability of all-oral interferon-free regimens for children within a few years,deferring treatment in clinically-stable children with CHC in anticipation of upcoming superior treatment modalities may be justified.

关键词： Hepatitis C virus Chronic hepatitis C Pediatric Children Anti-viral therapy

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Sofosbuvir Use in the Setting of End-stage Renal Disease:A Single Center Experience

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Journal of Clinical and Translational Hepatology 2017年第1期5卷 23-26页

作者： Avin Aggarwal Eric R.Yoo Ryan B.Perumpail George Cholankeril Radhika Kumari Tami J.Daugherty Alex S.Lapasaran Aijaz Ahmed Division of Gastroenterology and Hepatology Stanford University School of MedicineStanfordCAUSA Department of Medicine University of Illinois College of MedicineChicagoILUSA Division of Gastroenterology and Hepatology University of Tennessee Health Sciences CenterMemphisTNUSA Digestive Health Associates RenoNVUSA

Background and Aims:Patients with chronic hepatitis C (CHC) and end-stage renal disease (ESRD) who are dialysisdependent form a unique group,in which safety,tolerability and efficacy of sofosbuvir (SOF)-based direct-acting antivirals (DAAs) need further ***:We performed a retrospective analysis of 14 patients with CHC and ESRD on dialysis who received 15 courses of SOF-based *** evaluated dose escalation to standard-dose SOF in this proof-of-principle ***:Sustained virological response (defined as undetectable viral load at 12 weeks,SVR-12) was achieved in 13 out of the 15 (86.7%) treatment *** (46.6%) patients received reduced half dose as conservative proof-of-principal to mitigate potential *** 13 out of 15 treatment courses,patients completed the designated treatment *** patient was treated twice and developed SVR-12 with the *** patient was lost to follow-up and counted as a *** discontinuations were not due to DAA-related adverse *** were no reports of severe adverse effects or drug ***:We treated CHC patients with ESRD using dose escalation to standard-dose SOF in this proof-of-principle experience and achieved SVR rates comparable to general population.

关键词： Hepatitis C End-stage renal disease Sofosbuvir Direct-acting antivirals

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Expanding Treatment Access for Chronic Hepatitis C with Task-shifting in the Era of Direct-acting Antivirals

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Journal of Clinical and Translational Hepatology 2017年第2期5卷 130-133页

作者： Eric R.Yoo Ryan B.Perumpail George Cholankeril Channa R.Jayasekera Aijaz Ahmed Department of Medicine University of Illinois College of Medicine Chicago IL USA Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford CA USA Division of Gastroenterology and Hepatology University of Tennessee Health Sciences Center Memphis TN USA Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford CA USA Center for Innovation in Global Health Stanford UniversityStanford CA USA

In the United States,the fight to eradicate hepatitis C virus (HCV) infection has been ongoing for many years,but the results have been less than ***,patients with chronic hepatitis C (CHC) were treated with interferon-based regimens,which were associated with frequent adverse effects,suboptimal response rates,and long durations of treatment-of up to 48 *** from specialistphysicians,such as hepatologists and gastroenterologists,was needed to closely follow patients on these medications so as to monitor laboratory values and manage adverse ***,the emergence of direct-acting antiviral (DAA) agents against HCV infection have heralded outstanding progress in terms of safety,tolerability,lack of adverse effects,efficacy,and truncated duration of therapy-12 weeks or less-thereby making the need for close monitoring by specialist-physicians *** the recent approval of DAA agents by the Food and Drug Administration,the treatment model for CHC no longer relies on the limited number of specialist-physicians,which represented a major barrier to treatment access in the past,especially in underserved areas of the United *** propose and share our experiences in adapting a task-shifting treatment model,one that utilizes a relatively larger pool of non-specialist healthcare providers,such as nursing staff (medical assistants,vocational licensed nurses,registered nurses,etc.) and advanced practice providers (nurse practitioners and physician assistants),to perform a variety of important clinical functions in an effort to make DAA-based antiviral therapy widely available against HCV *** recently,task-shifting was implemented by the United States and World Health Organization in the fight against the human immunodeficiency virus and showed encouraging *** on our experiences in implementing this model at our outreach clinics,the majority of HCV-infected patients treated with DAA agents can be easily monitored by

关键词： Task-shifting Treatment Access Underserved Under-resourced Hepatitis C virus HCV Direct acting antivirals DAAs

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