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Cách Quản Lý Bệnh Nhân HCV Trên Thẩm Phân Máu?
Current Hepatology Reports - 2015
Tóm tắt
Tỉ lệ nhiễm virus viêm gan C (HCV) vẫn cao hơn ở bệnh nhân thẩm phân so với dân số chung, và nhiễm HCV mãn tính gây ra tỷ lệ morbid và tử vong đáng kể. Tác động tiêu cực này chứng tỏ sự cần thiết của việc sàng lọc định kỳ, đánh giá xơ hóa, và điều trị kháng virus bằng các thuốc kháng virus trực tiếp mới (DAAs). Ở bệnh nhân thẩm phân, DAAs nên được chỉ định cho tất cả bệnh nhân bất kể giai đoạn xơ hóa và họ có phải là ứng viên cho ghép thận hay không. Các phác đồ kết hợp grazoprevir/elbasvir hoặc paritaprevir/ritonavir, ombitasvir, dasabuvir ± ribavirin đã đạt được tỷ lệ đáp ứng vi rút bền vững (SVR) cao. Sofosbuvir không được khuyến cáo cho bệnh nhân có tỷ lệ lọc cầu thận (GFR) dưới 30 mL/phút. Liều hàng ngày thấp hơn của sofosbuvir và ribavirin đã dẫn đến kết quả không khả quan. Một số nghiên cứu với sofosbuvir kết hợp với simeprevir hoặc daclatasvir hoặc ledispasvir đã báo cáo SVR cao và dung nạp tốt, nhưng liều tối ưu của sofosbuvir cho bệnh nhân thẩm phân vẫn cần được làm rõ. Cần thiết có thêm các thử nghiệm lâm sàng về DDAs ở giai đoạn bệnh thận mãn tính (CKD) muộn.
Từ khóa
#virus viêm gan C #thẩm phân máu #thuốc kháng virus trực tiếp #tỷ lệ đáp ứng vi rút bền vững #bệnh thận mãn tínhTài liệu tham khảo
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