This document discusses the management of Hepatitis C in 2019 and beyond. It provides guidance on assessing liver disease, treatment aims and options, and available drugs in Pakistan. Key points include:
- Assessing liver disease involves tests of the blood, liver function, imaging and virological testing.
- Treatment aims to prevent liver complications and improve quality of life. The endpoint is an undetectable viral load 12 weeks post treatment (SVR12).
- Available drugs for genotype 3 infection include Sofosbuvir/Velpatasvir for 12 weeks in non-cirrhotic patients or Glecaprevir/Pibrentasvir for 8-12 weeks depending on fibrosis stage.
-
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
Crimson Publishers: Interferon-Free Therapy for Hepatits C in Brazil and Sust...CrimsonGastroenterology
Introduction: Hepatitis C has been treated with interferon and ribavirin for over a decade with described global sustained virological response rates of 33% to 56%. Direct acting antiviral drugs available since 2013 in USA and 2015 in Brazil are changing this reality.
Purpose: Analyze the real-life efficacy and safety of interferon-free therapy.
Methods: Repot six cases of different treatments guided by north-american and european guildelines.
Results: Every reported patient achieved sustained virological response. The only adverse event was anemia in one patient.
Conclusion: Direct-acting antiviral drugs will dramatically change the population which can be treated and increase sustained virological response rates.
Crimson Publishers: Interferon-Free Therapy for Hepatits C in Brazil and Sust...CrimsonGastroenterology
Introduction: Hepatitis C has been treated with interferon and ribavirin for over a decade with described global sustained virological response rates of 33% to 56%. Direct acting antiviral drugs available since 2013 in USA and 2015 in Brazil are changing this reality.
Purpose: Analyze the real-life efficacy and safety of interferon-free therapy.
Methods: Repot six cases of different treatments guided by north-american and european guildelines.
Results: Every reported patient achieved sustained virological response. The only adverse event was anemia in one patient.
Conclusion: Direct-acting antiviral drugs will dramatically change the population which can be treated and increase sustained virological response rates.
Chair, Anthony Martinez, MD, AAHIVS, FAASLD, prepared useful Practice Aids pertaining to HCV infection for this CME/MOC/NCPD/CPE activity titled “Sharing the Cure: Best Practices for Primary Care Providers to Improve HCV Prevention, Care, and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/CPE information, and to apply for credit, please visit us at https://bit.ly/3KQ6D3z. CME/MOC/NCPD/CPE credit will be available until April 20, 2023.
Work-up and management of chronic hepatitis B in non-pregnant adults, especially in a setting with limited resources such as Pakistan's healthcare system.
A power point presentation on Hepatitis C virus on epidemiology, presentation, diagnosis and current treatment strategies we are practicing in BSMMU at a international standerd.
Hepatitis (C) Story …. Past & Present & future
Most Recant Updating Guidelines by ASSLD & FDA
RAVS &How to deal with It ----12/7/2016.....
((Residents Lectures))
Author: Philip Bolduc, MD. New England AETC
This lesson will focus on the fundamentals of treating HCV infection. Understanding the treatment of HCV mono-infection is critical to mastering care of HIV/HCV co-infection.
Systemic treatment in advanced hepatocellular carcinoma (HCC) refers to the use of medications or therapies that are administered throughout the body to target cancer cells beyond the liver. HCC is the most common type of liver cancer and often presents at an advanced stage, making systemic therapies crucial in managing the disease.
One of the main categories of systemic treatment for advanced HCC is targeted therapies. Targeted therapies are designed to selectively inhibit specific molecules or pathways involved in tumor growth, thereby blocking the signals that support cancer cell survival and proliferation. Sorafenib and lenvatinib are examples of targeted therapies that have been approved for the first-line treatment of advanced HCC. They target vascular endothelial growth factor (VEGF) receptors, which play a key role in promoting the growth of new blood vessels necessary for tumor growth. By inhibiting these receptors, these drugs can help slow down tumor growth and improve patient outcomes.
In addition to sorafenib and lenvatinib, other targeted therapies have shown promising results in the treatment of advanced HCC. Regorafenib, for instance, is a multi-kinase inhibitor that targets several pathways involved in tumor angiogenesis, cell proliferation, and survival. Cabozantinib is another multi-kinase inhibitor that has been approved as a second-line treatment option for patients who have progressed on or are intolerant to prior systemic therapy. These targeted therapies have demonstrated efficacy in improving overall survival and delaying disease progression in patients with advanced HCC.
Another significant advancement in systemic treatment for advanced HCC is the use of immune checkpoint inhibitors. Immunotherapy has revolutionized cancer treatment in recent years, including for HCC. Immune checkpoint inhibitors, such as nivolumab and pembrolizumab, work by blocking proteins that act as checkpoints on immune cells, such as programmed cell death protein 1 (PD-1) or its ligand (PD-L1). By doing so, these drugs help restore and enhance the immune system's ability to recognize and eliminate cancer cells. Checkpoint inhibitors have shown promising results, with some patients experiencing durable responses and improved overall survival.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Hcv approach to management
1. Management of Hepatitis C
2019 and beyond
Dr S.Asif R Zaidi
MBBS FCPS
Gastroenterologist & Hepatologist
Interventional Endoscopist
Fellow Advance digestive Endoscopy
Shaikh Zayed Hospital Lahore
2. Road map for today
• How to asses liver disease ?
• Aims of therapy
• Basics of HCV virus
• Treatment options history
• DAAs classification
• Available drugs in Pakistan
• Treatment options of HCV
3.
4.
5.
6.
7. How to asses liver disease
• Other Blood-borne viruses.
• Vaccination
• Alcohol consumption
• Extra-hepatic manifestations
• Co morbidities
Cardiac ,renal ,metabolic, obestiy ,COPD,
. Hakeem medication / drug induced toxicity
8. Continue….
• HEMATOLOGICAL TEST
CBC PLATELETS ,PT APTT INR
• BIOCHEMICAL
LFTS ,ALBUMIN , RFTS
• RADIOLOGICAL
USG ABDOMEN LIVER AND SPLEEN SIZE PV SIZE
SWE
Biphasic CT if we suspect HCCa
European Association for The Study of The Liver. EASL Recommendations on
Treatment of Hepatitis C 2018. Journal of hepatology. 2018 Apr 9.
9. Virological test
• RDT /Elisa
• Nucleic acid
amplification test
(NAT)
• HCV RNA by PCR
HCV Core Antigen
• HCV Genotype
European Association for The Study of The Liver. EASL Recommendations on
Treatment of Hepatitis C 2018. Journal of hepatology. 2018 Apr 9.
10. HCV core antigen
• Marker of HCV replication.
• Core Antigen Detection can be used instead of HCV
RNA detection to diagnose acute or chronic HCV.
• Assays are less sensitive than HCV RNA
European Association for The Study of The Liver. EASL Recommendations on
Treatment of Hepatitis C 2018. Journal of hepatology. 2018 Apr 9.
11. Comparison between CRNA and Core
antigen
• HCV RNA PCR
• IU/ml
• Per patient cost 5884
PKR
• HCV core antigen by EIA
• fmol/L
• Per patient cost 2556
PKR
12. Current diagnostic frame work
• RDT to PCR model
RDT screening
Negative positive
PCR
negative
Positive
Treatment
• Silent features
PROS
• Logistically simple
Operationally simple
CONS
• Not very cost effective
• Prone to false negative
5% of cases
• Low PPV for PCR 66%
13. Aims and end point of HCV therapy
• Prevent the complications of HCV-related liver.
• Improve quality of life and remove disgrace.
• Prevent onward transmission of HCV.
• End point undetectable SVR12 ≤15 IU/ml
European Association for The Study of The Liver. EASL
Recommendations on Treatment of Hepatitis C 2018. Journal of
hepatology. 2018 Apr 9.
14. who should be treated?
• Patients with significant fibrosis (METAVIR score F2 or F3)
or cirrhosis (METAVIR score F4), including decompensated
cirrhosis.
• Extra-hepatic manifestations.
• HCV recurrence after liver transplantation.
• Iv drug ,
• Homosexuals
• Women of childbearing age who wish to get pregnant.
• Hemodialysis patients.
• Prisoners.
15. • Patients with MELD score ≥18–20 should be
transplanted first and treated after
transplantation (B1).
• If the waiting time on a liver transplant list is
more than 6 months, they can be treated
although the clinical benefit for these patients
is not well established (B2).
European Association for The Study of The
Liver. EASL Recommendations on
Treatment of Hepatitis C 2018. Journal of
hepatology. 2018 Apr 9
32. Treatment of HCV genotype 3 infection
• The following regimens (A1):
1. Sofosbuvir (400 mg)& Velpatasvir (100 mg)
2. Glecaprevir (300 mg)&Pibrentasvir (120mg)
3. Sofosbuvir (400 mg),velpatasvir (100 mg)
and voxilaprevir (100 mg)
European Association for The Study of The Liver. EASL
Recommendations on Treatment of Hepatitis C 2018. Journal of
hepatology. 2018 Apr 9.
33. Genotype 3, Pangenotypic:
Sofosbuvir/velpatasvir
• Treatment-naive and treatment-experienced
patients infected with HCV genotype 3
without cirrhosis should be treated with the
fixed-dose combination of sofosbuvir and
velpatasvir for 12 weeks (A1).
34. Genotype 3, Pangenotypic:
Sofosbuvir/velpatasvir
• Sofosbuvir and velpatasvir is not recommended in
treatment-naive and treatment-experienced
patients with HCV genotype 3 with compensated
(Child-Pugh A) cirrhosis, because suboptimal
results have been reported with this combination
• (B2).
35. Genotype 3, Pangenotypic:
Glecaprevir/pibrentasvir
• Treatment-naive no fibrosis (METAVIR score
F0-F2) glecaprevir and pibrentasvir for 8
weeks (A1).
• Treatment-naive ,with advanced fibrosis
(METAVIR score F3), but without cirrhosis, can
be treated with the fixed-dose combination of
glecaprevir and pibrentasvir for 8 weeks (B2).
36. Treatment experienced
• Treatment-experienced patients infected with
HCV genotype 3 without cirrhosis should be
treated with the fixed-dose combination of
glecaprevir and pibrentasvir for 12 weeks (B1).
• Treatment-naive patients infected with HCV
genotype 3 with compensated (Child-Pugh A)
cirrhosis should be treated with the fixed-dose
combination of glecaprevir and pibrentasvir for
12 weeks (B1).
37. • Treatment-experienced patients infected with
HCV genotype 3 with compensated (Child-
Pugh A) cirrhosis should be treated with the
fixed-dose combination of glecaprevir and
pibrentasvir for 16 weeks (B1).
38. Treatment of patients DCLD with or
without an indication for liver transplantation
• IFN-free regimens are the only options in HCV
• Protease inhibitor-containing regimens are
contraindicated in patients with
decompensated (Child-Pugh B or C) cirrhosis
(A1).
39. Treatment options for naïve,treatment
exp,with or with out compensated
cirrhosis patients
40.
41. For our patients in PK
• Sof + Vel 12 weeks for naïve.
• Sof + Dac 12 weeks for naïve.
• Sof +dacla + Riba for treatment exp and cirhotics 24 weeks.
• Sof + Vel + riba for treatment exp and cirhotics 12 weeks
• Generic drugs can be used, provided that quality controls are met
and guaranteed by the provider (A1).
European Association for The Study of The Liver. EASL
Recommendations on Treatment of Hepatitis C 2017 Journal of
hepatology. 2017
I will be talking about only for genotype 3 here as this is our main concern.
So whenever HCV patient comes to you. You should talk to your self
Is he just got HCV infection or is he cirrhotic?
Like this young man a bit worried of needle prick here
But looks ok
Walks in and sitting comfortably
So you said to your self he looks ok
So he is not cirrhotic until proven other wise.
Or like this gentleman even doctor is having blind faith on him.
And I am sure he don’t!
Joke apart …..
So when patient like this comes in you said ok this is a problematic area.
And he really need your attention otherwise he will fade away in quick time.
So every one likes to catch patient in early phase of the disease.
We should be looking for other causes of chronic liver disease, or factors which are
likely to affect the natural history or progression of liver disease like metabolic liver problems, and should be systematically investigating the patient.
All patients should be tested for other HBV and (HIV).
Those who are negative for HBV and HAV should be vaccinated.
One must enquire for alcohol consumption and talking to your patient to decrease or quit alcohol intake.
One must be curious for
Hematological
Biochemical
Radiological
Virological
Assessment of liver disease severity is necessary prior to therapy.
Identifying patients with cirrhosis (METAVIR score F4) or
advanced (bridging) fibrosis (METAVIR score F3) is of particular
importance, as the choice of treatment regimen and the post treatment
prognosis depend on the stage of fibrosis.
Assessment of the stage of fibrosis is not required in patients with clinical
evidence of cirrhosis.
The diagnosis of acute and chronic HCV infection is based on
the detection of HCV RNA in serum or plasma by a sensitive,
exclusively quantitative,molecular method. An assay with a lower limit of detection
≤15 international units (IU)/ml is recommended.
There is an important need for diagnostic nucleic acid assays that are cheap
(less than US$5-10)
In serum or plasma is a marker of HCV
replication. Core antigen detection can be used instead of HCV
RNA detection to diagnose acute or chronic HCV infection.
HCV core antigen assays are less sensitive than HCV RNA assays
(lower limit of detection equivalent to approximately 500 to
3,000 HCV RNA IU/ml, depending on the HCV genotype2,3
HCV RNA assessment should be made by a reliable sensitive
assay, and HCV RNA levels should be expressed in IU/ml.
HCV core antigen detection and quantification can be performed when HCV RNA tests are not available and/or not affordable.
HCV core antigen quantification should be done and core antigen levels should
be expressed in fmol/L.
The goal of therapy is to cure HCV infection in order to: (i) prevent
the complications of HCV-related liver and extra-hepatic
Disease, including hepatic necroinflammation, fibrosis, cirrhosis,
decompensation of cirrhosis, HCC, severe extra-hepatic
manifestations and death; (ii) improve quality of life and
remove stigma associated with it (iii) prevent onward transmission of HCV.
The endpoint of therapy is an SVR, defined by undetectable
HCV RNA in serum 12 weeks (SVR12) or 24 weeks
(SVR24) after the end of therapy, as assessed by a sensitive
molecular method with a lower limit of detection ≤15 IU/ml
Treatment must be considered without delay in patients with significant fibrosis (METAVIR score F2 or F3) or cirrhosis (METAVIR score F4), including decompensated cirrhosis.
Patients with clinically significant extra-hepatic manifestations.
Patients with HCV recurrence after liver transplantation.
Individuals at high risk of transmitting HCV Iv drug ,homosexuals, women of childbearing age who wish to get pregnant haemodialysis patients, incarcerated persons ).
kilobase
Basic idea was to enhance immune response against HCV virus and some how stops its replication.
And that’s why there were lots of problems with them. So at around 2015 that’s goes out with the arrival of daclatasvir
Sovaldi approval (First approved December 6th, 2013)
Daklinza (First approved July 24th, 2015)
Harvoni approval date Oct. 10, 2014
Vekira pak Dec 19, 2014
Zepatiar on 28 January 2016.
Epclusa June 28, 2016
Vesovi July 18, 2017
Mevyret August 3, 2017
This is where we want to stop chronic hepatitis C not allowing cirrhosis to set in and protecting our patients
Causes of cirhosis
This is a non invasive method
Every one have LFTs
So for getting APRI score you need to devide pts AST with normal AST and then deviding it with platelets and multiplying it by 100 you will get this score
If more then 1 cirrhosis is there if 0.5 normal liver
If your patients below 7 that is absent or mild fibrosis
If 75 F4cirhosis
A 100 % one year 85% 2years survival
B 81% one year 57% 2 years
C 45% one year 35 % two years
By putting Billi INR and creatinine in this formula you will have MELD
This serve two things prirotizing patients for liver transplant and 3 months mortality
MELD > 20 3 month mortality of 20%
MELD > 40 3 months mortality of >70%
The fixed-dose combination of glecaprevir (300 mg)
and pibrentasvir (120 mg) in three tablets containing
100 mg of glecaprevir and 40 mg of pibrentasvir,
administered once daily with food;
This recommendation is based on the results of
the phase III ASTRAL-3 trial in patients with HCV genotype 3
infection (29% with compensated cirrhosis, 74% treatment naive,
26% treatment-experienced) treated with the fixed-dose
combination of sofosbuvir and velpatasvir for 12 weeks.
The SVR12 rates were 98% (160/163) in treatment-naive patients
without cirrhosis.
Lower SVR12 rates were observed in patients who were treatment-experienced or had cirrhosis with this regimen:
overall 90%
Thus, the addition of a third drug to this
regimen is necessary, at least in patients infected with genotype
3 with compensated cirrhosis, justifying the use of the triple
combination of sofosbuvir, velpatasvir and voxilaprevir in this
Group.
As you have noticed there is no daclatasvir ribavirin here and the treatment duration of 24 weeks is out and all having 8 or 12 weeks treatment duration
But our experience with these available drugs are too good
We will be keep using these drugs till they will be available OTC.