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Abstract
RÉSUMÉ
But. L'introduction récente du sofosbuvir au Cameroun représente une étape importante dans le traitement des génotypes 1, 2 et 4 de l'hépatite C chronique (CHC). Les données sur l'efficacité de cette association au Cameroun sont rares. Le but de cette étude était de caractériser la réponse à l'association sofosbuvir ribavirine avec ou sans interféron pégylé au Cameroun. Méthodes. Nous avons inclus de manière consécutive des CHC 1,2 et 4 adultes de deux centres de traitement publics et d'un centre de traitement privé au Cameroun. Les patients admissibles devaient avoir toutes les réponses virologiques documentées. Les dossiers médicaux des patients qui ont demandé un traitement ont été systématiquement examinés par un comité. L'efficacité a été évaluée par réponse virologique rapide (RVR), réponse de fin de traitement (ETR); et réponse virologique soutenue (RVS). Les événements indésirables ont été enregistrés. Les données ont été analysées en utilisant le test de Chi-deux de Pearson ou le test exact de Fisher, selon le cas. Résultats: Nous avons inclus 72 patients âgés de 31 à 82 ans. Une charge virale élevée était présente dans 65,2% des cas. Les génotypes 1,2 et 4 représentaient respectivement 29,2%, 51,4% et 19,4%. Nous avons eu 33,3% de patients cirrhotiques et 84,7% de patients naïfs. 83,3% (60/72) des patients ont atteint la réponse virologique rapide. La réponse en fin de traitement était présente chez 91,6% (66/72) et la réponse virale soutenue chez 91,6%. Conclusion.
ABSTRACT
Background: The recent introduction of sofosbuvir in Cameroon represent an important step in the treatment of genotypes 1, 2 and 4 Chronic Hepatitis C (CHC). Data on efficacy of this combination in Cameroon are scarce. The aim of this study was to characterize the response to sofosbuvir ribavirin combination with or without pegylated interferon in Cameroon. Methods: We consecutively included consented CHC 1,2 and 4 adults from two publics and one private treatment centers in Cameroon. Eligible patients were required to have all virological response documented. The medical records of patients who sought treatment were systematically reviewed by a committee. Efficacy was assessed by Rapid Virological Response (RVR), End of Treatment Response (ETR); and Sustained Virological Response (SVR). Adverse events were recorded. Data were analysed using Pearson's Chi-square test or Fisher's exact test as appropriate. Results: We included 72 patients aged 31 to 82 years. A high viral load was present in 65.2%. Genotypes 1,2 and 4 accounted respectively for 29.2%,51.4% and 19.4%. We had 33.3% cirrhotic and 84.7% naïve patients. RVR was achieved by 83.3% (60/72) of patients; ETR by 91.6% (66/72) and SVR by 91.6% (66/72). Conclusion: The formal protocol was pegylated interferon plus ribavirin and we added sofosbuvir. The therapeutic response is by far better than the one without Direct Acting Antiviral (DAA).
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References
- World Health Organisation. Guidelines for the screening, care and treatment of persons with hepatitis C infection updated version. WHO. 2016.
- Mohd HK, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013 Apr 1;57(4):1333–42.
- Madhava V, Burgess C, Drucker E. Epidemiology of chronic hepatitis C virus infection in sub-Saharan Africa. Lancet Infect Dis. 2002 May;2(5):293–302.
- Njoya O, Ntsama L, Essi MJ et al. Therapeutic response of black africans in the treatment of genotype 2 chronic viral hepatitis C by pegylated interferon-ribavirine. Austin J Gastroenterol. 2014;1(2):1009.
- Njoya O, Ndong EE, Essi MJ et al. Therapeutic response to pegylated interferon alpha-2a and ribavirine in genotype 4 chronic hepatitis C in sub saharan africans. JSM Gastroenterol Hepatol. 2015;3(2):1041.
- Reddy KR, Hoofnagle JH, Tong MJ et al. Racial differences in responses to therapy with interferon in chronic hepatitis C. Consensus Interferon Study Group. Hepatol Baltim Md. 1999 Sep;30(3):787–93.
- Webster DP, Klenerman P, Dusheiko GM. Hepatitis C. The Lancet. 2015 Mar;385(9973):1124–35.
- Koff RS. Review article: the efficacy and safety of sofosbuvir, a novel, oral nucleotide NS5B polymerase inhibitor, in the treatment of chronic hepatitis C virus infection. Aliment Pharmacol Ther. 2014 Mar 1;39(5):478–87.
- Lawitz E, Mangia A, Wyles D et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med. 2013 May 16;368(20):1878–87.
- Zeuzem S, Dusheiko GM, Salupere R et al. Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med. 2014 May 22;370(21):1993–2001.
- Ruane PJ, Ain D, Stryker R al. Sofosbuvir plus ribavirin for the treatment of chronic genotype 4 hepatitis C virus infection in patients of egyptian ancestry. J Hepatol. 2015 May 1;62(5):1040–6.
- Gaglio PJ, Rodriguez-Torres M, Herring R et al. Racial differences in response rates to consensus interferon in HCV infected patients naive to previous therapy. J Clin Gastroenterol. 2004 Aug;38(7):599–604.
- Yasui K, Okanoue T, Murakami Y et al. Dynamics of hepatitis C viremia following interferon-alpha administration. J Infect Dis. 1998; 177:1475-9.
- Stedman C. Sofosbuvir, a NS5B polymerase inhibitor in the treatment of hepatitis C: a review of its clinical potential. Ther Adv Gastroenterol. 2014 May;7(3):131–40.
- Wiley TE, Brown J, Chan J. Hepatitis C infection in african americans: its natural history and histological progression. Am J Gastroenterol. 2002; 97: 700-6.
- Njoya O. Voies de transmission et mode de contamination des hépatites virales. In: Njoya O. Hépatites virales en mots simples. Paris: L'Harmattan; 2013. p. 37-40.
- Njoya O, Tchoupe D, Mawaguia JP et al. Safety of the association of pegylated interferon and ribavirin in the treatment of chronic viral hepatitis C in the blacks: a ten year observation. Gastroenterol Hepatol. 2015;2(5):00053.
References
World Health Organisation. Guidelines for the screening, care and treatment of persons with hepatitis C infection updated version. WHO. 2016.
Mohd HK, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013 Apr 1;57(4):1333–42.
Madhava V, Burgess C, Drucker E. Epidemiology of chronic hepatitis C virus infection in sub-Saharan Africa. Lancet Infect Dis. 2002 May;2(5):293–302.
Njoya O, Ntsama L, Essi MJ et al. Therapeutic response of black africans in the treatment of genotype 2 chronic viral hepatitis C by pegylated interferon-ribavirine. Austin J Gastroenterol. 2014;1(2):1009.
Njoya O, Ndong EE, Essi MJ et al. Therapeutic response to pegylated interferon alpha-2a and ribavirine in genotype 4 chronic hepatitis C in sub saharan africans. JSM Gastroenterol Hepatol. 2015;3(2):1041.
Reddy KR, Hoofnagle JH, Tong MJ et al. Racial differences in responses to therapy with interferon in chronic hepatitis C. Consensus Interferon Study Group. Hepatol Baltim Md. 1999 Sep;30(3):787–93.
Webster DP, Klenerman P, Dusheiko GM. Hepatitis C. The Lancet. 2015 Mar;385(9973):1124–35.
Koff RS. Review article: the efficacy and safety of sofosbuvir, a novel, oral nucleotide NS5B polymerase inhibitor, in the treatment of chronic hepatitis C virus infection. Aliment Pharmacol Ther. 2014 Mar 1;39(5):478–87.
Lawitz E, Mangia A, Wyles D et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med. 2013 May 16;368(20):1878–87.
Zeuzem S, Dusheiko GM, Salupere R et al. Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med. 2014 May 22;370(21):1993–2001.
Ruane PJ, Ain D, Stryker R al. Sofosbuvir plus ribavirin for the treatment of chronic genotype 4 hepatitis C virus infection in patients of egyptian ancestry. J Hepatol. 2015 May 1;62(5):1040–6.
Gaglio PJ, Rodriguez-Torres M, Herring R et al. Racial differences in response rates to consensus interferon in HCV infected patients naive to previous therapy. J Clin Gastroenterol. 2004 Aug;38(7):599–604.
Yasui K, Okanoue T, Murakami Y et al. Dynamics of hepatitis C viremia following interferon-alpha administration. J Infect Dis. 1998; 177:1475-9.
Stedman C. Sofosbuvir, a NS5B polymerase inhibitor in the treatment of hepatitis C: a review of its clinical potential. Ther Adv Gastroenterol. 2014 May;7(3):131–40.
Wiley TE, Brown J, Chan J. Hepatitis C infection in african americans: its natural history and histological progression. Am J Gastroenterol. 2002; 97: 700-6.
Njoya O. Voies de transmission et mode de contamination des hépatites virales. In: Njoya O. Hépatites virales en mots simples. Paris: L'Harmattan; 2013. p. 37-40.
Njoya O, Tchoupe D, Mawaguia JP et al. Safety of the association of pegylated interferon and ribavirin in the treatment of chronic viral hepatitis C in the blacks: a ten year observation. Gastroenterol Hepatol. 2015;2(5):00053.