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Publication
Antivirais de ação direta na hepatite C
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Abstract(s)
A infeção pelo vírus da Hepatite C é considerado um grave problema de saúde pública a nível mundial, pois apresenta uma elevada taxa de evolução para a cronicidade, com possível evolução para cirrose hepática e/ou carcinoma hepatocelular. De facto, a OMS estima que, mundialmente, cerca de 71 milhões de pessoas vivam com a infeção crónica pelo HCV, e que a mortalidade associada à Hepatite C já tenha atingindo números comparáveis aos da tuberculose e mais altos do que os do HIV.
Atualmente não existe nenhuma vacina disponível para o vírus da Hepatite C e a probabilidade de se vir a desenvolver uma vacina eficaz no futuro próximo é reduzida. Sendo assim, a única forma de evitar mortalidade e morbilidades associadas ao HCV é através do tratamento.
Na última década, têm surgido novas opções terapêuticas para a Hepatite C, que vieram revolucionar o tratamento de primeira linha desta patologia e erradicar a Hepatite C crónica na grande maioria dos doentes. Estas opções terapêuticas, que vieram permitir a cura em taxas superiores a 95%, correspondem aos Antivirais de Ação Direta (AAD). As diferentes combinações de classes de AAD (inibidores da protease NS3 / 4A, da polimerase NS5B e do complexo de replicação NS5A) permitem tratamentos muito potentes. As combinações de, pelo menos, duas destas três principais classes de fármacos resulta numa resposta virológica sustentada (RVS) com apenas 8 a 12 semanas de tratamento. Atualmente, com os vários esquemas terapêuticos aprovados, a escolha e a duração do tratamento depende principalmente de alguns fatores como a presença de cirrose e/ou de coinfeções. Estas novas terapêuticas de AAD combinadas e sem IFN têm elevada eficácia virológica, melhoram a segurança e tolerabilidade e, consequentemente, são as melhores armas disponíveis para erradicar a Hepatite C.
The Hepatitis C (HCV) infection is a serious worldwide public health problem due to the high progression rate to become chronic and due to the evolutive potential to become a hepatic cirrhosis and a hepatocellular carcinoma (CHC). In fact, the World Health Organization estimates that 71 million people live with the HCV chronic infection all over the world and that the mortality because of the disease had already reached numbers that can be compared to the tuberculosis ones and higher than the HIV ones. Currently there is not any vaccine against the infection by the HCV and the probability of developing one soon is very low. Therefore, the only way to avoid deaths because of the HCV is by getting the treatment. On the last decade, new therapeutic options for the Hepatitis C appeared, those new options meant a revolution on the first line treatment of this pathology and they also eradicated the chronic Hepatitis C in the most part of the patients. These new therapeutic options, which enabled healing rates higher that 95%, are the Direct-Acting Antiviral Agents (DAAs). The different combinations of the DAAs types (NS3/4A protease inhibitors, NS5B polymerase inhibitors and NS5A compounds targeting inhibitors) allow very powerful treatments. The combination of, at least, two of these three main medicine types result in a sustained virologic response, with only eight to twelve weeks of treatment. Nowadays, with the several therapeutic plans that were approved, the choice and the duration of the treatment depend mostly on previous factors, like the presence of cirrhosis and co-infections. These therapies of DAAs combined and without IFN have high virologic effectiveness, improve safety and tolerability and, consequently, are the best methods to eradicate the Hepatitis C.
The Hepatitis C (HCV) infection is a serious worldwide public health problem due to the high progression rate to become chronic and due to the evolutive potential to become a hepatic cirrhosis and a hepatocellular carcinoma (CHC). In fact, the World Health Organization estimates that 71 million people live with the HCV chronic infection all over the world and that the mortality because of the disease had already reached numbers that can be compared to the tuberculosis ones and higher than the HIV ones. Currently there is not any vaccine against the infection by the HCV and the probability of developing one soon is very low. Therefore, the only way to avoid deaths because of the HCV is by getting the treatment. On the last decade, new therapeutic options for the Hepatitis C appeared, those new options meant a revolution on the first line treatment of this pathology and they also eradicated the chronic Hepatitis C in the most part of the patients. These new therapeutic options, which enabled healing rates higher that 95%, are the Direct-Acting Antiviral Agents (DAAs). The different combinations of the DAAs types (NS3/4A protease inhibitors, NS5B polymerase inhibitors and NS5A compounds targeting inhibitors) allow very powerful treatments. The combination of, at least, two of these three main medicine types result in a sustained virologic response, with only eight to twelve weeks of treatment. Nowadays, with the several therapeutic plans that were approved, the choice and the duration of the treatment depend mostly on previous factors, like the presence of cirrhosis and co-infections. These therapies of DAAs combined and without IFN have high virologic effectiveness, improve safety and tolerability and, consequently, are the best methods to eradicate the Hepatitis C.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Hepatite C aguda Hepatite C crónica Terapêutica antiviral Antivirais de ação direta