title: [Diagnosis, treatment, and follow-up of hepatitis C-virus related liver disease. Hungarian national consensus guideline].
abstract: Approximately 70 000 people are infected with hepatitis C virus in Hungary, more than half of whom are not aware of their infection. Early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases (liver cirrhosis and liver cancer) and its complications. In addition, it may increase work productivity and life expectancy of infected individual, and can prevent further viral transmission. Early recognition can substantially reduce the long term financial burden of related morbidity from socioeconomic point of view. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can kill the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of two direct acting first generation protease inhibitor drugs (boceprevir and telaprevir) to the dual therapy increased the chance of sustained clearance of virus to 63-75% and 59-66%, respectively. These two protease inhibitor drugs are available and financed for a segment of Hungarian patients since May 2013. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. For initiation of treatment as well as for on-treatment decisions accurate and timely molecular biology tests are mandatory. Staging of liver damage (fibrosis) non-invasive methods (transient elastography and biochemical methods) are acceptable to avoid concerns of patients related to liver biopsy. Professional decision for treatment is balanced against budget limitations in Hungary, and priority is given to those with urgent need using a national Priority Index system reflecting stage of liver disease as well as additional factors (activity and progression of liver disease, predictive factors and other special circumstances). All naïve patients are given a first chance with dual therapy. Those with genotype 1 infection and with on-treatment or historic failure to dual therapy are eligible to receive protease inhibitor based triple therapy provided, they reach financial cutoff eligibility based on Priority Index. Duration of therapy is usually 48 weeks in genotype 1 with a response-guided potential to reduce duration for non-cirrhotic patients. Patients with non-1 genotypes are treated with dual therapy (without protease inhibitors) for a genotype and response driven duration of 16, 24, 48, or 72 week. Careful monitoring for early recognition and management of side-effects as well as viral response and potential breakthrough during protease-inhibitor therapy are recommended.
authors.affiliation: Somogy Megyei Kaposi Mór Oktató Kórház Belgyógyászati Osztály Kaposvár Tallián Gyula u. 20-32. 7400 Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs.
authors.forename: Béla
authors.initials: B
authors.lastname: Hunyady
authors.affiliation: Szent György Egyetemi Oktató Kórház I. Belgyógyászat és Molekuláris Diagnosztikai Laboratórium Székesfehérvár.
authors.forename: Judit
authors.initials: J
authors.lastname: Gervain
authors.affiliation: Szent János Kórház és Észak-budai Egyesített Kórházak Hepatológiai Szakrendelés Budapest.
authors.forename: Gábor
authors.initials: G
authors.lastname: Horváth
authors.affiliation: Egyesített Szent István és Szent László Kórház Budapest.
authors.forename: Mihály
authors.initials: M
authors.lastname: Makara
authors.affiliation: Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs.
authors.forename: Alajos
authors.initials: A
authors.lastname: Pár
authors.affiliation: Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Szalay
authors.affiliation: Egyesített Szent István és Szent László Kórház Budapest.
authors.forename: László
authors.initials: L
authors.lastname: Telegdy
authors.affiliation: Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum Belgyógyászati Intézet Debrecen.
authors.forename: István
authors.initials: I
authors.lastname: Tornai
mesh_terms: D000465:Algorithms; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D032921:Consensus; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D016898:Interferon-alpha / Q000627:therapeutic use; D007372:Interferons / Q000008:administration & dosage / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000517:prevention & control; D008113:Liver Neoplasms / Q000517:prevention & control; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012367:RNA, Viral / Q000302:isolation & purification; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011480:Protease Inhibitors; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D007372:Interferons; C100416:peginterferon alfa-2a
keywords: boceprevir; directly acting antiviral drug; direkt ható antivirális szer; hepatitis C virus; hepatitis C-vírus; interferon; liver carcinoma; liver cirrhosis; májrák; májzsugor; pegilált interferon; pegylated interferon; protease inhibitor; proteázgátló; ribavirin; telaprevir; viral hepatitis; vírushepatitis