Diagnosis and treatment of chronic hepatitis C.
The procedure recommended by the Czech Society for Hepathology and the Society for Infectious Diseases of J. E. Purkyně Czech Medical Society.

Česká verzia

Authors: P. Urbánek ¹; P. Husa ²; J. Šperl ³ ; P. Kümpel (koordinátoři) ⁴; J. Galský ⁵; P. Hůlek ⁶; V. Němeček ⁷; S. Plíšek ⁸; M. Volfová ⁹
Authors place of work: IV. interní klinika 1. lékařské fakulty UK a VFN, Praha, přednosta doc. MUDr. Aleš Žák, DrSc. ¹; Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Petr Husa, CSc. ²; Klinika hepatogastroenterologie IKEM, Praha, přednosta doc. MUDr. Julius Špičák, CSc. ³; Infekční oddělení Slezské nemocnice, Opava, přednosta prim MUDr. Petr Kümpel ⁴; Infekční oddělení nemocnice, Mělník, přednosta prim MUDr. Jan Galský ⁵; II. interní klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ⁶; Národní referenční laboratoř pro virové hepatitidy Státního zdravotního ústavu, Praha, ředitel MUDr. Jaroslav Volf, Ph. D. ⁷; Infekční klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta doc. MUDr. Václav Dostál ⁸; Hepato-Gastroenterologie HK s r. o., Hradec Králové ⁹
Published in the journal: Vnitř Lék 2005; 51(11): 1307-1313
Category: Guidelines

Datum vydání doporučení: červenec 2005

Summary

The prevalence of hepatitis C virus infection (HCV) in the Czech Republic is 0.2 %. On the world scale, between 180 and 200 million of persons are infected. The standard therapeutic procedure for HCV infection indicated for antiviral therapy is the combination of α pegylated interferon (PEG-IFN) and the ribavirin virostatic (RBV). Treatment is indicated for a period between 24 and 48 weeks, depending on the input parameters before the start of the treatment (especially the HCV genotype and viremia). The above virological parameters and the extent of liver damage are the most important factors of prognosis for therapy. Constant virological response (CVR) which is regarded as the criterion for recovery from infection is achieved by combined PEG-IFN therapy in approximately 50 % of cases. Antiviral therapy may have a number of different undesirable and serious side effects and cannot be applied indiscriminately to all HCV infection cases. Also significant is the price of the drugs used. There is clear evidence that application of antiviral therapy using all standard, process-defined procedures defined by „evidence-based medicine“ brings by all means more advantages than treatment of patients with an advanced liver disease. The proposed standard diagnostic and therapeutic procedure was developed by representatives of viral hepatitis work groups of the Czech Society for Hepathology and the Society for Infectious Diseases on the basis of the latest recommendations of several international expert societies. In addition to description of typical and uncomplicated HCV infection cases, the paper provides a detailed analysis of procedures applied to cases of advanced liver damage comparable with liver cirrhosis. A separate section is dedicated to the issue of patients with HCV/HIV co-infection, patients at different stages of renal insufficiency, with constantly normal ALT activity, and some extra-hepathic symptoms of HCV infection.

Key words:
Hepatitis C virus – interferon – pegylated interferon – ribavirin