Hcv Escalando Dr Lee

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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

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