title: [Hepatitis C treatment in special patient groups].
abstract: The treatment plan for chronic hepatitis C in special populations varies according to comorbidity and the current evidence on treatment. In patients with hepatitis C virus and HIV coinfection, the results of dual therapy (pegylated interferon plus ribavirin) are poor. In patients with genotype 1 infection, triple therapy (dual therapy plus boceprevir or telaprevir) has doubled the response rate, but protease inhibitors can interact with some antiretroviral drugs and provoke more adverse effects. These disadvantages are avoided by the new, second-generation, direct-acting antiviral agents. In patients who are candidates for liver transplantation or are already liver transplant recipients, the optimal therapeutic option at present is to combine the new antiviral agents, with or without ribavirin and without interferon. The treatment of patients under hemodialysis due to chronic renal disease continues to be dual therapy (often with reduced doses of pegylated interferon and ribavirin), since there is still insufficient information on triple therapy and the new antiviral agents. In mixed cryoglobulinemia, despite the scarcity of experience, triple therapy seems to be superior to dual therapy and may be used as rescue therapy in non-responders to dual therapy. However, a decision must always be made on whether antiviral treatment should be used concomitantly or after immunosuppressive therapy.
authors.affiliation: Servicio de Aparato Digestivo. Hospital Universitario La Fe, Valencia, España.
authors.forename: Marina
authors.initials: M
authors.lastname: Berenguer
authors.affiliation: Servicio de Aparato Digestivo. Complejo Asistencial Universitario de León, León, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Jorquera
authors.affiliation: Servicio de Aparato Digestivo. Hospital Clínico, Universidad de Valencia, Valencia, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ángel Serra
authors.affiliation: Servicio de Aparato Digestivo. Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: Ricard
authors.initials: R
authors.lastname: Sola
authors.affiliation: Servicio de Aparato Digestivo. Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: gregorio.castellano@salud.madrid.org.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Castellano
mesh_terms: D019380:Anti-HIV Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003449:Cryoglobulinemia / Q000188:drug therapy / Q000209:etiology; D019468:Disease Management; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005544:Forecasting; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D016030:Kidney Transplantation; D016031:Liver Transplantation; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D011480:Protease Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000628:therapy
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D011480:Protease Inhibitors
keywords: Boceprevir; Chronic hepatitis; Coinfección por virus C y virus de la inmunodeficiencia humana; Crioglobulinemia mixta; Hemodialysis; Hemodiálisis; Hepatitis C virus; Hepatitis C virus and HIV coinfection; Hepatitis crónica; Interferon; Interferón; Liver transplantation; Mixed cryoglobulinemia; Ribavirin; Ribavirina; Telaprevir; Trasplante hepático; Virus de la hepatitis C