Bc s NGUYN HU CH

B Mn Nhim, i hc Y Dc TP HCM

Bnh VGSV C l mt vn ton cu, cn quan tm iu tr gim nguy c !

3-4 triu ngi mi nhim mi nm trn ton th gii! 2003: c tnh khong 170 triu ngi b nhim HCV (khong 3,1% dn s ton cu)

Prevalence of infection > 10% 2.5% to 10.0% 1.0% to 2.5% NA

World Health Organization 2008. Available at: http://www.who.int/ith/es/index.html.

Siu vi C (Hepatitis C = HCV), tc nhn gy bnh mi

Family: Genus: Genome: Kch thc: Tng sinh: Genotype: Cu to: Flaviviridae Hepacivirus Dy RNA xon, n 60-80 nm Trong gan 11 genotypes (1-6 chim 90%) Lp v do 2 protein c cu E1 v E2 to ra

Cu ti di truyn ca HCV

Hepatitis C

Nomenclature of genotypes

Da vo cu to di truyn, ngi ta chia HCV lm 6 genotypes chnh v 11 subtypes (Simmonds et al.) Genotype Subtype
1a, 1b, 1c 2a, 2b, 2c 3a, 3b 4a 5a 6a

1 2 3 4 5 6

HCV genotype thay i theo a d!

1, 2, 3
Chu M 13,1 triu (1.7%)

Chu u 8.9 triiu (1.03%)

1
4 4 3 3

Asia: 6 1,3 ng Nam

Ty Thi Bnh Dng 1, 3 62.2 trieu (3.9%)

32.3 trieu (2.15%)

Chu Phi 31.9 triu (5.3%)

4 4,5

a Trung Hi : 21.3 triu (4.6%)

Common Genotype

Worldwide: 6

World Health Organization. Hepatitis C: global prevalence: update. 2003. Farci P, et al. Semin Liver Dis. 2000;20:103-126. Wasley A, et al. Semin Liver Dis. 2000;20:1-16.

Cc loi HCV genotypes Chu Thi Bnh Dng

Korea
69% 13% 18% HCV-1: HCV-2: Other: 68% 25% 8%

China
HCV-1: HCV-2: Other:

Japan
HCV-1: HCV-2: HCV-3: Other: 67% 30% 1% 2%

Taiwan Middle East

HCV-1: HCV-2: Other: 2% 91% 7% HCV-1: HCV-2: Other: 53% 40% 8%

India
HCV-1: HCV-2: HCV-3: HCV-4: Other: 14% 6% 67% 3% 11%

Southeast Asia
HCV-1: HCV-2: HCV-3: 74% 4% 23%

Australia/ New Zealand HCV-1:

HCV-1: HCV-2: HCV-3: HCV-4: HCV-6: 52% 9% 32% 6% 2% HCV-2: HCV-3: HCV-6: Other:

Macau, Vietnam, Hong Kong

50% 8% 7% 30% 5%

Yu ML and Chuang WL. J Gastroenterol Hepatol 2009; 24: 336

c tnh nhim HCV s gia tng trong nhng nm sp ti ti Hoa K

M hnh ton hc v din bin t nhin ca VGSV C mn tnh
BN nhim HCV 2949 (N x 103): BN c bin chng (n x 103)

2870

2682

2444

2117 X gan X gan mt b HCC Cht v bnh gan

1000
800 600 400 200 0

2000

2010

2020 Nm

2030

2040

Davis GL, et al. Liver Transplantation. 2003;9:331-338.

D on v VGSV C
Trong vng 10 nm, s BN b x gan mt b do VGSV C tng > 4 ln [1] Tng chi ph y t dnh cho VGSV C d on tng t 30 t USD vo nm 2009 ln > 85 t USD vo nm 2024[1] Vo nm 2011, d on c khong 500.000 BN mc

VGSV C khng p ng vi iu tr. [2]

1. Milliman, Inc. Consequences of HCV: Costs of a baby boomer epidemic, 2009. Available at: http://www.milliman.com/expertise/healthcare/publications/rr/consequences-hepatits-c-virus-RR05-15-09.php. 2. Decision Resources HCV Report & Interactive Forecast Tool 2005.

Din bin t nhin ca nhim HCV

Din bin t nhin ca nhim HCV

Nhim cp Khi 15% - 45% n 75% - 95% n 97% - 99%/nm Nhim HCV 55% - 85% X gan 5% - 25%

HCC hoc gan mt b 1% - 3%/nm

Infection with HCV can also cause extrahepatic diseases including mixed cryoglobulinemia, types II and III

Thomas DL, et al. Clin Liver Dis. 2005;9:383-398 Strader DB, et al. Eur J Gastroenterol Hepatol. 1996;8:324-328. Seeff LB, et al. Hepatology. 2002;36(suppl):S1-S2. Seeff LB, et al. Hepatology. 2002;36(suppl):S35-S46. Liang TJ, et al. Ann Intern Med. 2000;132:296-305. Fattovich G, et al. Gastroenterology. 1997;112:463-472.

Ung nhiu ru lm tng nguy c x gan BN nhim HCV

100 80 X gan (%) 60 40 20 P < .01 58 P < .01 64 40 HCV HCV + alcohol* P < .01 85

18 6
12 10

31

20 30 Nm sau nhim trng

40

*Excessive alcohol intake characterized as > 40 g/day for women and > 60 g/day for men. Duration of exposure defined as either first blood transfusion before 1990 or from the year of initial intravenous drug use. Wiley TE, et al. Hepatology. 1998:28:805-809.

Khng iu tr, VGSV C din bin sang bin chng v tng nguy c t vong!
(chm)

30 nm sau nhim trng N, tr tui

Mt b (~20%) HCC (14% /nm) Hn m gan (0.4%/nm) XH do v TM dn (1.1%/nm)

T l din bin

Gan bnh thng

Nhim trng cp Khi t nhin (20%)

Nhim trng mn tnh (80%)

VGSV mn

X gan (20%) Din bin chm (~75%)

Bng bng

(2.5%/nm)

(Nhanh)

20nm sau nhim trng

Ung nhiu ru, bo ph, ng nhim vi HBV, HIV

Buti M, et al. J Hepatol 2000; 33: 651 Lauer G & Walker B. N Engl J Med 2001; 345: 41

HCC = hepatocellular carcinoma

p ng ng khng th v cc XN chn on nhim HCV

Ch im huyt thanh trong bnh VGSV C mn tnh

Nhim trng neg HCV core Ag HCV RNA

(+)

Anti-HCV ALT

10

12

Diagnostic window Thng

Nm

Tm sot nhim HCV l bc u trn con ng cha khi bnh!

nh gi Cha khi

Xt nghim

iu tr

Tham vn Tm sot

iu tr bnh VGSV C phc tp, cn theo di thng xuyn nh gi p ng v pht hin tc dng ph.

Mc tiu iu tr
Mc tiu:
Tiu dit siu vi v cha khi bnh. Ngn nga bin chng v t vong

Xc nh v duy tr p ng iu tr
Bnh thng ha ALT
Gim nng SV n di ngng pht hin Ci thin m hc

KT QU IU TR NH GI BNG SVR, NNG SIU VI DI NGNG PHT HIN 6 THNG SAU KHI NGNG THUC.
Ghany MG, et al. Hepatology. 2009;49:1335-1374.

BN c ch nh iu tr v c nhiu ngi chp nhn

c im
> 18 tui HCV RNA (+)/mu Sinh thit gan: VGSV mn, x ha nng

Gan cn b *
XN sinh ha & huyt hc chp nhn c BN sn sng iu tr v tun th iu tr Khng c chng ch nh
*Total serum bilirubin < 1.5 g/dL; INR < 1.5; serum albumin > 3.4; platelet count = 75,000/mm 3; and no evidence of hepatic decompensation (hepatic encephalopathy or ascites). Hemoglobin > 13 g/dL for men and > 12 g/dL for women; neutrophil count > 1500/mm 3 and serum creatinine < 1.5 mg/dL).
Ghany MG, et al. Hepatology. 2009;49:1335-1374. Reprinted with permission from the American Association for the Study of Liver Diseases. Copyright 2009

BN c iu tr theo tng tnh hung ring bit!

c im
Tht bi iu tr (khng p ng & ti pht) vi IFN alfa +/- RBV hoc pegIFN alfa n thun BN nghin ma ty hoc nghin ru nhng sn sng tham gia chng trnh chng nghin Sinh thit gan: khng c hoc c x ha nh VGSV C cp ng nhim HIV/HCV < 18 tui Bnh thn mn tnh X gan mt b Ngi c ghp gan
Ghany MG, et al. Hepatology. 2009;49:1335-1374. Reprinted with permission from the American Association for the Study of Liver Diseases. Copyright 2009

Chng ch nh iu tr bnh VGSV C mn tnh

c im
Suy nhc thn kinh nng khng kim sot c Ghp tng Bnh t min

Bnh tuyn gip

Ph n mang thai Bnh ni khoa nng: Cao HA, suy tim, bnh mch vnh, tiu ng khng kim sot c, COPD < 2 tui D ng vi thuc trong phc iu tr

Ghany MG, et al. Hepatology. 2009;49:1335-1374. Reprinted with permission from the American Association for the Study of Liver Diseases. Copyright 2009

Phc iu tr bnh VGSV C mn tnh

B sung RBV vo pegIFN: tng ETR v gim ti pht Thi gian iu tr ti u da vo HCV genotype

Genotype 1/4 PegIFN (tun)

PegIFN alfa-2a 180 g

PegIFN alfa-2b 1.5 g/kg

RiBaVirin (ngy)

1000 mg, CN 75 kg 1200 mg, CN > 75 kg

800 mg, CN 65 kg 1000 mg, CN > 65 - 85 kg 1200 mg, CN > 85 - 105 kg 1400 mg, CN >105 kg
48 w PegIFN alfa-2b 1.5 g/kg 800 mg 24 w

Thi gian Genotype 2/3 PegIFN (tun) RBV (ngy) Thi gian

48 w PegIFN alfa-2a 180 g 800 mg 24 w

Ghany MG, et al. Hepatology. 2009;49:1335-1374.

Cc kiu p ng ca HCV di tc dng ca iu tr

Ban u iu tr Khng p ng

HCV RNA

Ti pht
Ngng pht hin HCV RNA (di ngng pht hin) p ng SV lu di (Sustained virological response = SVR) (cure)

THI GIAN

6 thng

SVR, yu t c xem nh khi bnh!

- Tp hp 9 nghin cu ngu nhin, a trung tm, vi 1.343 BN (1.077 t bng PegIFN + RBV; 166 t bng PegIFN n thun, trong c 79 BN c ALT: bt, 100 BN ng nhim HIV/HCV). - SVR: HCV RNA < 50IU/ml, 6 thng sau ngng t. - TD trung bnh: 3,9 nm (thay i t 0,8 n 7,1 nm).

KT QU:

- SVR trong thi gian nghin cu: 99,1% - 0,9% BN c HCV RNA xut hin vo khong 1,8 nm (1,2-2,9 nm).
Kt qu SVR (chung) 1.343 (99,1) VGSV C Monotherapy ALT: bt 166 (98,8) VGSV C Combotherapy ALT tng 998 (99,1) VGSVC Combotherapy ALT: bt 79 (100) HIV/HCV Mono/Combotherapy ALT: tng 100 (99)

N (%)

Swain MG et al A sustained virologic response is durable in patients with chronic hepatitis C treated with Peginterferon alfa-2a and Ribavirin Gastroenterology 2010;139:1593-1601

T l SVR thay i theo phc iu tr

100
80 SVR (%) 60 40 20 n = 505 0 IFN + RBV 514 PegIFN alfa-2b 0.5 + RBV 800 800 PegIFN alfa-2b 1.5 + RBV 800 n= 224 IFN + RBV 444 PegIFN alfa-2a 453 PegIFN alfa-2a + RBV 10001200 47 47 54* 44 29 56 Manns et al[1] Fried et al[2]

*P = .01 vs both arms, P = .001 vs both arms

1. Manns MP, et al. Lancet. 2001;358:958-965. 2. Fried MW, et al. N Engl J Med. 2002;347:975-982.

Kt qu iu tr VGSV C ngi Chu cao hn dn Caucases

Genotype 1 (48 w Peg-IFN -2a 180 g/tun + ribavirin 10001200 mg/ngy) Genotype 2/3 (24 w Peg-IFN -2a 180 g/tun + ribavirin 800 mg/ngy)

100 80
SVR (%) 751 56.52* 501 801 651

871 771

851

60
40 20 0

Chinese

Caucasian

Korean

Taiwanese

* Population comprised 78.1% genotype 1 patients 1. Yu M-L and Chuang W-L. J Gastro and Hepatol 2009; 24: 336 2. Ma LN, et al. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2006; 20: 42

Trong qu trnh iu tr cn theo di LS & XN vo cc thi im cn thit

Mc ch: nh gi p ng iu tr v tc dng ph
CTM, creatinine, ALT v HCV RNA:
W4, 12, 24 v 4 n 12w sau, 24 w sau khi ngng

iu tr Chc nng tuyn gip mi 12 w Tc dng ph v suy nhc TK: Khm hng thng trong 12 w u, sau 8 n 12w, cho n chm dt iu tr
Ghany MG, et al. Hepatology. 2009;49:1335-1374.

Cc kiu p ng ca HCV
PegIFN alfa and RBV
7 HCV RNA (log10 IU/mL) 6 5 4 3 Ti pht 2 p ng tng phn * Khng p ng*

1
0 -8

Khng pht hin

RVR
-4 -2 0 4 8

EVR
12 16 20 24 32 40

ETR
48 52 60

SVR
72

Tun sau khi bt u iu tr

*Subset of Nonresponse
Ghany MG, et al. Hepatology. 2009;49:1335-1374. Reprinted with permission from the American Association for the Study of Liver Diseases. Copyright 2009

p ng siu vi nhanh
(Rapid Virologic Response = RVR)
t RVR: SVR[1] cao c lp vi genotype v phc iu tr t RVR: 15% - 20% HCV genotype 1; 66% HCV genotypes 2/3[1,2] t RVR : c th rt ngn thi gian iu tr [1,3] Khng t RVR khng phi l tiu chun ngng iu tr

1. Ferenci P, et al. J Hepatol. 2005;43:425-433. 2. Shiffman ML, et al. N Engl J Med. 2007;357:124-134. 3. Jensen DM, et al. Hepatology. 2006;43:954-960. 4. Ghany MG, et al. Hepatology. 2009;49:1335-1374.

BN nhim HCV genotype 1 t c RVR c th rt ngn thi gian iu tr

Nghin cu hi cu, a trung tm, a quc gia, ngu nhin, phase III : pegIFN

alfa-2a + RBV (N = 740)

Din bin khi BN t c RVR
24 w 48 w

Din bin BN khng t RVR

100
80 60 40 20 0

97

93

88

91
Patients (%)

100
80 60 44 40 70 63

BN (%)

23
20 0

ETR

SVR

ETR

SVR

Jensen DM, et al. Hepatology. 2006;43:954-960.

T l SVR BN nhim HCV Genotype 2/3 t c RVR (iu tr ngn)

BN t c RVR khi dng PegIFN alfa-2a + RBV[1,2]
Von Wagner et al[2] 100 82 80 SVR (%) 60 40 20 0 16 Wks (n = 71) *P = .002 vs 16 wks.
1. Von Wagner M, et al. Gastroenterology. 2005;129:522-527. 2. Shiffman M, et al. N Engl J Med. 2007;357:124-134.

Shiffman et al[2]

100
80 SVR (%) 80 60 40 20 0 24 Wks (n = 71) 16 Wks (n = 733) 24 Wks (n = 732) 79

85*

Thi gian iu tri ko di nu BN khng t c RVR

BN c iu tr bng PegIFN alfa-2a + RBV (800 mg/ngy)

ETR 100 80 Patients (%) 61 60 40 20 0 48 Wks (n = 165) 32 48%

SVR 26% 61 45*

T l ti pht
P = .003

72 Wks (n = 161) Thi gian iu tr

*P = .014 vs 48 wks.

Sanchez-Tapias JM, et al. Gastroenterology. 2006;131:451-460.

p ng siu vi sm (early virologic response = EVR) gip tin lng SVR BN VGSV C
Khng t EVR: khng p ng iu tr [1,2] 97% - 100% BN khng t EVR s khng t SVR BN khng t EVR c th ngng iu tr t EVR : tin lng SVR[3] t tin cy hn 65% - 72% BN t EVR s t c SVR cEVR c gi tr tin lng SVR nhiu hn pEVR[3] 83% vs 21%, t c SVR [2] Gi tr tin lng ca EVR thp hn BN HCV genotype 2/3 [3]
1. Fried MW, et al. N Engl J Med. 2002;347:975-982. 2. Davis GL, et al. Hepatology. 2003;38:645-652. 3. Ghany MG, et al. Hepatology. 2009;49:1335-1374.

Thi gian iu tr ngn v BN nhim HCV genotype 1 c nng siu vi ban u thp
24 vs 48 wks pegIFN alfa-2b + RBV BN nhim HCV genotype 1 c nng

HCV RNA < 600,000 IU/mL

24-wk : RBV theo cn nng 48-wk : RBV 800 mg/ngy

BN t c SVR

SVR ty thuc vo thi im HCV RNA u tin m tnh 93 100 89 85 71 80 67 60 40 20 0 Wk 4 50

Thi gian iu tr

25

24 wks 48 wks

17

Wk 12 Wk 24 Total Thi im HCV RNA u tin m tnh

Zeuzem S, et al. J. Hepatol. 2006;44:97-103.

ALT bnh thng khng phi l yu t hon ho xc nh nng ca bnh gan!

X ha gan t trm trng BN c ALT bnh thng ALT[1-2] Tuy nhin, x ha v x gan vn c th xy ra BN c ALT bnh thng [3]
100 Normal ALT (n = 58) Elevated ALT (n = 37)

80 Patients (%)
60 40 23 20 0 19 39 26 24 19

16
6

22

6
Cirrhosis

No fibrosis

Mild Portal Bridging Severity of Liver Disease

1. Martinot-Peignoux M, et al. Hepatology. 2001;34:1000-1005. 2. Nutt AK, et al. Am J Med. 2000;109:62-64. 3. Shiffman ML, et al. J Infect Dis. 2000;182:1595-1601.

Hiu qu ca PegIFN BN nhim HCV c ALT bnh thng

BN c 3 ln ALT bnh thng trong > 18 thng, c chn ngu nhin iu tr bng pegIFN alfa-2a 180 g/wk + RBV 800 mg/ngy hoc khng iu tr

100
80

Khng iu tr (n = 69) 24 w pegIFN + RBV (n = 212) 48 w pegIFN + RBV (n = 210)

P < .001

72
P < .001

78

SVR (%)

60 40 20 0 0 Tt c 30

52

40

13 0

0
Genotypes 2/3

Genotype 1

Zeuzem S, et al. Gastroenterol. 2004;127:1724-1732.

iu tr VGSV C cho tr em
anti-HCV khng thc hin thng quy tr s sinh c m nhim HCV v khng th ny c th di chuyn t m sang con
HCV RNA c th xem xt thc hin khong 1-2 thng sau sanh nu mun chn on sm. Anti-HCV nn lm khi tr 18 thng.

Tr em 2-17 tui c th xem xt iu tr theo tiu chun ging nh ngi ln.

Phc iu tr: pegIFN alfa-2b 1.5 g/1.73 m2/wk + RBV 15 mg/kg/ngy

Ghany MG, et al. Hepatology. 2009;49:1335-1374.

Hiu qu ca PegIFN alfa-2b + RBV tr em b VGSV C

Nghin cu m 62 tr dng pegIFN alfa-2b 1.5 g/kg/wk + RBV 15 mg/kg/ngy trong 48 wks Thay i liu pegIFN v tc dng ph xy ra trong 31% BN, ngng thuc 7% BN

100
80

100

SVR (%)

60
40 20 0

59 48

Tt c

Genotype 1 (n = 46)

Genotypes 2/3 (n = 13)

Wirth S, et al. Hepatology. 2005;41:1013-1018.

PegIFN RBV vs Standard IFN BN ng nhim HIV/HCV

868 BN ng nhim HCV/HIV, chn ngu nhin iu tr bng standard IFN alfa-2a + RBV, pegIFN alfa-2a + placebo, hoc pegIFN alfa-2a + RBV trong 48 wks

100
80
P < .001

IFN alfa-2a + RBV (n = 285) PegIFN alfa-2a + placebo (n = 286) PegIFN alfa-2a + RBV (n = 289)
61 P < .001

SVR (%)

60
40 20 0

40
20 12 n= Tt c 82 22

34

33 15 7 203 206 208 HCV RNA ban u > 800,000 IU/mL

79

79

HCV RNA ban u 800,000 IU/mL

Torriani F, et al. N Engl J Med. 2004;351:438-450.

Hiu qu ca PegIFN + RBV BN ng nhim HCV/HIV

100 80 Tt c BN Genotype 1

SVR (%)

60

40
20 0

40
29

44

38 27
14 27 17

PegIFN alfa-2a + RBV 800[1]

PegIFN alfa-2a + RBV 600-1000[2]

PegIFN alfa-2b + RBV 800[3]

Peg IFN alfa-2b + RBV 800-1200[4]

1. Torriani F, et al. N Engl J Med. 2004;351:438-450. 2. Chung R, et al. N Engl J Med. 2004;351:451-459. 3. Carrat F, et al. JAMA. 2004;292:2839-2848. 4. Laguno M, et al. AIDS. 2004;18:F27-F36.

iu tr bnh VGSV C cp
BN b VGSV C cp nn xem xt iu tr bng IFN.
iu tr nn bt u mun, khong 8-12 weeks sau khi

pht. IFN chun, n tr liu. Xem xt dng pegIFN v tin dng. Cha xc nh c thi gian iu tr ti u, c l nn ko di khong 12 wks (24 wks c nhiu ngi ng h). Vn dng RBV : ty trng hp.

Ghany MG, et al. Hepatology. 2009;49:1335-1374.

iu tr c th lm gim bin chng x gan c lin quan n HCV

Nghin cu hi cu 479 bnh nhn VGSV C c x ha nng hoc x

gan trong khong 1990-2003

5 trung tm ti Chu u v Canada Ishak score: 4-6

Thi gian theo di trung bnh: 2,1 nm (IQR: 0.8-4.9) 30% t SVR (n = 142) t suy gan nu BN t SVR 5-yr rate: 0% vs 13.3%; HR: 0.03 (95% CI: 0-0.91)

Veldt BJ, et al. Ann Intern Med. 2007;147:677-684.

Bin chng vn c th xy ra BN x gan do HCV t c SVR !

HCC vn c th xy ra d BN t c SVR
100 80 HCC (%) 60 40 20 0 0
No SVR At risk Events SVR At risk Events 337 0 142 0 5-Yr Occurrence SVR: 9.2% (CI: 0.0% to 19.6%) No SVR: 13.1% (CI: 7.6% to 18.6%) P = .192 (log likelihood)

No SVR SVR

1
259 5 76 0

2
188 8 48 1

3
153 13 35 1

4 Yrs
117 18 24 3

5
90 22 14 3

6
71 27 8 3

7
43 29 6 3

8
30 30 5 3

Veldt BJ, et al. Ann Intern Med. 2007;147:677-684. Reproduced with permission.

Tc dng ph ca PegIFN
BN nn theo di thng xuyn cc tc dng ph khi dng thuc. Bt li thng gp nht l st, lnh run, nhc u, mt mi, au c,

ri lon tm l.

Cng / T l / nng

Suy nhc TK
Mt mi Lo u Tr/c gi cm 0 1 2 Thng 3 4

Keeffe EB, et al. Clin Gastroenterol Hepatol. 2008;6:1315-1341.

Tc dng ph do PegIFN/RBV
Hu ht BN dng pegIFN v RBV c 1 tc dng ph

trong qu trnh iu tr [1]

Tc dng ph l l do gim liu hoc b iu tr. [1] Tc dng ph l nguyn nhn ca 10% n 14% b iu

tr [2,3]
Tc dng ph thng gp nht l :
Gi cm (mt mi, nhc u, st, n lnh): > 50% Tm thn (suy nhc TK, bc rc, mt ng): 22% - 31%

1. Ghany MG, et al. Hepatology. 2009;49:1335-1374. 2. Manns MP, et al. Lancet. 2001;358:958-965. 3. Fried MW, et al. N Engl J Med. 2002;347:975-982.

Tc dng ph (XN) ca PegIFN/RBV

Gim BC (ANC < 1500/mm3): 18% - 20%[1,2] Gim BC nng * (ANC < 500/mm3): 4% Nhim trng nng t gp v G-CSF t khi cn n [3] Thiu mu (Hb < 12 g/dL): ~ 30%[1,2] Trong vng 6-8 wks Thiu mu nng (Hb < 10 g/dL): 9% - 15% Bt thng huyt hc l l do thng gp nht ca gim liu
*And treatment discontinuation. And dose modification.
1. Manns MP, et al. Lancet. 2001;358:958-965. 2. Fried MW, et al. N Engl J Med. 2002;347:975-982. 3. Soza A, et al. Hepatology. 2002;36:1273-1279.

Phng nga
Hn ch ng ly:

- Tm sot ngi nhim. - Hn ch tip xc vi mu/dch tit c cha HCV. HIN NAY CHA C THUC CHNG NGA BNH VGSV C MN TNH

1. Bnh VGSV C l bnh c th cha khi.

2. Trong qu trnh iu tr cn theo di thng xuyn

nng siu vi: W4, W12, W24, W48 v W72 3. Theo di tc dng ph ca thuc iu chnh liu lng. 4. Lu cc bnh km theo, c th iu tr mt cch thch hp.