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8/3/2019 Hcv Escalando Dr Lee
http://slidepdf.com/reader/full/hcv-escalando-dr-lee 1/13
Hepatitis C: escalando la cima
Banff, 31/3/08
Canadian Consensus guidelines
for treating HCV genotype 1
Dr Samuel S. Lee
Universidad de Calgary
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Bienvenidos a Banff
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Speaker declaration
Research support: Human Genomics,
Microgenix, Roche, Schering, Idenix,
BMS, Gilead, Virochem, GSK, Novartis Consultant: Genentech, Idenix,
Microgenix, Roche, BMS, Novartis,
Virochem
Speakers Bureau: Roche, Gilead, BMS
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Objectives
Canadian consensus guidelines for
management of HCV genotype 1
Compare with Mexican guidelines
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Canadian Consensus Guidelines
2007 Acute HCV: similar to Mexican guidelines:
anicteric cases: Rx with PEG-IFN 24wk
(G-1) or 12 wk (G-2/3) as soon as possible icteric cases: observe up to 12 wk;
consider Rx if no resolution
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2007 Canadian guidelines ±
chronic HCV: who to treat? ALT does not matter
Biopsy considered but not necessary
Fibrosis stages 1-4 Compensated cirrhosis
Active in jection users / methadone can be
considered for Rx
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.
TRYING TO IMPROVE
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Canadian guidelines ± chronic HCV
genotype 1 HCV RNA PCR testing (IU/mL) should be
done at baseline, and wk 4,12, end-of-Rx,
and wk24 post-Rx
If wk 4 ±ve (RVR), treat for 24 wk unless
poor risk factors (advanced fibrosis, HVL,
obese, older, African-American, HIV,
immunosuppression)
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Canadian guidelines ±genotype 1
Wk 12: if no EVR, stop Rx
If complete EVR (virus negative), Rx 48
wk If partial EVR (detectable but >2log
decline), wk 24 HCV RNA: if +ve, stop Rx
If wk 24 ±ve, consider Rx for 72 wk
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Previous Rx failures
Relapsers/nonresponders to alfa-IFNmonotherapy: retreat with PEG +RBV
Relapsers to alfa-IFN + RBV: retreat withPEG +RBV
Nonresponders to alfa-IFN + RBV:retreatment with PEG+RBV may be
considered Relapsers/nonresponders to PEG+RBV:
no retreatment
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Supermodelo vs Modelo
Pamela Anderson
HCV