Fatores prognósticos e de efetividade do tratamento da hepatite C crônica

Abstract

Chronic C hepatitis is a recently recognized entity which treatment efficacy is not definitely established. The aim of this study is to know the prognostic factors for sustained virologic response and effectiveness of the treatment, as well as propose a theoretical model concerning its main issues. Brazilian prevalence of hepatitis C is around 0,94% to 1,89%, with an increasing tendency. Prisoners, drug addicts and patients in dialysis are at greater risk of infection. Related complications tend to increase in the next decades due to the chronic and progressive disease s character. Only part of treated patients obtain virologic sustained response even in optimal conditions. VHC genotype, pretreatment viral load, viral kinetic, aminotransferases levels, fibrosis, gender, age, body weight, race, steatosis and treatment adherence are prognostic factors associated with a sustained virologic response. According to the Brazilian control strategy peguilated interferon is used for treatment of genotype 1 and conventional interferon for genotypes 2 and 3. Other factors act along virologic sustained response for treatment effectiveness, such as related costs, early diagnosis, quality and availability of medication, pólos de aplicação , early stop criteria implementation, reduced number of retreatments and liver transplantations. In conclusion, to improve hepatitis C treatment effectiveness is necessary to optimize screening programs, implement more pólos de aplicação and make viral kinetic viable.