HEPATITIS C: WHO SHOULD BE TREATED?

Liječenje je nužno u bolesnika s akutnom infekcijom, bolesnika s povišenim vrijednostima ALT-a, bolesnika s normalnim vrijednostima ALT-a i prisutnom fibrozom od najmanje F2 po METAVIR sustavu ili fibrozom dokazanom nekom neinvazivnom metodom utvrđivanja fibroze, nonrespondera i relapsera genotipa 1 na ranije primijenjenu antivirusnu terapiju (trojna terapija - pegilirani interferon, ribavirin, bocaprevir ili telaprevir), bolesnika s kompenziranom cirozom jetre te bolesnika na hemodijalizi. Liječenje dolazi u obzir u bolesnika s kod koinfekcijom HBV i HIV-om, u bolesnika s teškim ekstrahepatičnim manifestacijama HCV infekcije, u bolesnika ovisnih o teškim drogama i alkoholu nakon najmanje 6 mjeseci apstinencije, moguće i uz suportivnu terapiju metadonom i buprenorfinom, te bolesnika s transplantiranom jetrom. Terapija se ne preporučuje bolesnicima s fulminantnim hepatitisom, bolesnicima s normalnim ALT-om bez prisutne fibroze te bolesnicima s transplantiranim bubregom i trudnicama.Therapy is strongly recommended in patients with acute infection, patients with elevated ALT levels, patients with normal ALT level and F ≥2 METAVIR score, in genotype 1 nonresponders and relapsers to antiviral therapy with triple therapy (pegylated interferon, ribavirin, bocaprevir or telaprevir), in patients with compensated cirrhosis and patients on hemodialysis. It is possible to treat patients with HBV and HIV co-infection, patients with severe HCV extrahepatic manifestations and patients with transplanted liver. Drug users and alcoholics can be treated after 6-month abstinence, but also with supportive therapy. This therapy is not recommended in patients with fulminant hepatitis, patients with persistent normal ALT levels and without fibrosis, in kidney transplant recipients and in pregnant women