Hepatitis C: escalando la cima Banff, 31/3/08

Canadian Consensus guidelines for treating HCV genotype 1

Dr Samuel S. Lee Universidad de Calgary

Bienvenidos a Banff

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

Objectives
Canadian consensus guidelines for management of HCV genotype 1 Compare with Mexican guidelines

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

2007 Canadian guidelines chronic HCV: who to treat?

ALT does not matter Biopsy considered but not necessary Fibrosis stages 1-4 Compensated cirrhosis Active injection users / methadone can be considered for Rx

TRYING TO IMPROVE

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)

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

Previous Rx failures
Relapsers/nonresponders to alfa-IFN monotherapy: retreat with PEG +RBV Relapsers to alfa-IFN + RBV: retreat with PEG +RBV Nonresponders to alfa-IFN + RBV: retreatment with PEG+RBV may be considered Relapsers/nonresponders to PEG+RBV: no retreatment

Supermodelo vs Modelo

HCV

Pamela Anderson