الفهرس 
Chronic hepatitis C virus infectionOnly 14 pages are availabe for public view
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Abstract
Hepatitis C is an infectious disease caused by hepatitis c virus, it is mainly transmitted by unsafe injection practices and procedures such as renal dialysis; hepatitis c virus causes both acute and chronic infection.
The prevalence of Hepatitis c virus infection in Egypt is the highest in the world where chronic infection with HCV is the leading cause of end stage liver disease, hepatocellular carcinoma and liver related deaths.
In the past Interferon alpha alone had only limited success in treatment of chronic HCV infection but major advance came with the addition of the broad-spectrum antiviral agent ribavirin, which more than doubled the sustained response rate to 35–40%, further improvement has recently been achieved by the development of pegylated interferon which when used in combination with ribavirin yields sustained response rates of 54–56%.
A greater understanding of the hepatitis C virus genome and proteins has led to the development of multiple direct-acting antivirals (DAAs), which are medications that target specific steps within the HCV life cycle.
DAA-based treatment of HCV is considered one of the greatest recent achievements in the field of hepatology and forms the cornerstone of the plan aiming for eradication of HCV infection worldwide; however, viral resistance- which means positive selection of viral variants with reduced susceptibility to a certain DAA when it is administered- is the main problem with all of the target therapies and for this reason choosing the optimal strategy of retreatment of patients with prior DAA treatment failure need more investigations and is considered a necessity with high priority.
Retreatment of patients with prior DAA treatment failure depends mainly on usage of a combination of multiple DAAs of different viral targets and different resistance profiles and this will increase antiviral treatment activity and achieve higher sustained virological response rates in shorter duration of treatment.
The most effective strategy up to date is the usage of Sofosbuvir as backbone therapy plus a drug from a class other than that previously used and ribavirin should also be added to consider triple or quadruple DAA regimen unless ribavirin is contraindicated.
The aim of this study is to determine the efficacy of Qurevo- Sovaldi- Ribavirin regimen as a retreatment strategy in NS5A inhibitors (Sofosbuvir & Daclatasvir) resistant patients infected with chronic hepatitis C virus.
Our study was done on twenty (20) chronic hepatitis C virus infected patients that were treated with Sofosbuvir and Daclatasvir and ribavirin for 12 weeks but without any response on viral load so their new retreatment strategy composed of the triple therapy (Qurevo-Sofosbuvir-Ribavirin) was started for 12 weeks and the primary efficacy endpoint was set 12 weeks after the last dose of the new regimen of treatment.
Sofosbuvir was given in a dose of 400 mg/day, and a fixed-dose combination of ombitasvir (25 mg),paritaprevir (150 mg),and ritonavir (100 mg) taken with food once daily. Ribavirin was supplied in 200 mg capsules, and the recommended dose was 600 mg/day to reach 1200 mg/day based on patient’s body weight and tolerability.
All patients were subjected to the following:
-full medical history
-clinical examination
-the following laboratory investigations:
1-PCR techniques (before treatment and after 3 months from the last dose)
2-kidney function tests
3-liver function tests
4-AFP (Alfa feto-protein)
5-Serum albumin
6-Complete blood picture (CBC)
-abdominal ultrasound
*inclusion criteria
Individuals were included if they were 18 years or more, clinically stable conditions as outpatient, child’s A hepatic patient and Ns5a resistant chronic hepatitis C virus patients
*exclusion criteria
Individuals were excluded if they were child’s B or C hepatic patients, confirmed pregnant or lactating females, inadequately controlled diabetic patients, patients with hepatocellular carcinoma or Extra- hepatic malignancy except after two years of disease free interval and patients with a platelet count less than 50000/mm
The results showed that PCR (× 103) before treatment ranged from 1.32-4000 with mean value 574.3±1155.6 but after treatment all cases achieved sustained virological response after 12 weeks of the last dose of treatment (SVR12).