title: [Chronic hepatitis C: patients with mild disease].
abstract: Chronic hepatitis C virus infection is usually asymptomatic. The severity of the hepatic lesion in these patients at diagnosis varies and, from the histopathologic point of view, most have mild disease. A series of factors have been described that correlate with the progression of fibrosis in patients with mild fibrosis: age at diagnosis, the duration of the infection, male sex, HIV coinfection, transaminase levels during follow-up, alcohol consumption, metabolic factors such as diabetes and overweight, necroinflammatory activity in the initial biopsy, and the degree of steatosis. In patients with genotype 1 hepatitis C infection, the standard treatment has been pegylated interferon and ribavirin. However, response rates are markedly increased by concomitant use of first-generation protease inhibitors, boceprevir or telaprevir. In patients with moderate fibrosis, these drugs are well tolerated, in addition to being effective. Currently, dual therapy should be reserved for patients with good baseline predictive factors of response and/or contraindications for treatment with telaprevir or boceprevir. In patients with genotypes other than genotype 1, the standard treatment continues to be the combination of pegylated interferon and ribavirin, although the development of new direct-acting antiviral agents such as sofosbuvir and simeprevir will change the strategies used in these patients. The decision to wait for the new treatments is complex because their release date is unknown; likewise, their high cost will limit the possibilities for their use.
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario Joan XXIII, Tarragona, España.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Quer
authors.affiliation: Servicio de Aparato Digestivo, Hospital General, Valencia, España.
authors.forename: Moisés
authors.initials: M
authors.lastname: Diago
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Crespo
authors.affiliation: Servicio de Aparato Digestivo, Hospital Carlos III, Madrid, España.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Samaniego
authors.affiliation: Servicio de Aparato Digestivo, Hospital Germans Trias i Pujol, Badalona (Barcelona), España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Morillas
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Málaga, España.
authors.forename: Raúl
authors.initials: R
authors.lastname: Andrade
authors.affiliation: Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza, España. Electronic address: masimonmarco@gmail.com.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ángel Simón
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D002986:Clinical Trials as Topic; D015897:Comorbidity; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology; D008111:Liver Function Tests; D008297:Male; D015337:Multicenter Studies as Topic; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D035703:Therapies, Investigational; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors
keywords: Boceprevir; Chronic hepatitis; Hepatitis C virus; Hepatitis crónica; Interferon; Interferón; Ribavirin; Ribavirina; Telaprevir; Virus de la hepatitis C