Recomendaciones para el tratamiento de la Hepatitis Crónica por Virus C en pacientes con insuficiencia renal crónica, en diálisis o trasplantados renales. Indicaciones de tratamiento 2018
Resumen
En el año 2012 la Asociación Argentina para el Estudio de las Enfermedades del Hígado presentó las primeras guías de práctica clínicas referidas al tratamiento de la hepatitis crónica por virus C (HCV). En 2014 se publicó un Consenso Argentino de Hepatitis C, en el que se revisaron todos los temas concernientes a esta enfermedad. Los sucesivos avances en el tratamiento de la hepatitis C crónica nos llevan a actualizar estas guías en forma periódica. Las sociedades científicas dedicadas al estudio de las enfermedades hepáticas: American Association for the Study of Liver Diseases (AASLD), European Association for the Study of the Liver (EASL), Asociación Latinoamericana para el Estudio del Hígado (ALEH), Organización Mundial de la Salud (OMS) y Asian-Pacific Association for the Study of the Liver (APASL), han actualizado sus guías en base a los ultimos tratamientos aprobados por la FDA (Food and Drug Administration) en Estados Unidos y por la EMA (European Medicines Agency) para la hepatitis C. Dado el rápido avance en las investigaciones y desarrollo de nuevos tratamientos, la guía de la AASLD se actualiza periódicamente y sólo se publica online.
El manejo de los pacientes con insuficiencia renal crónica avanzada, en hemodiálisis y los pacientes con trasplante renal implica un desafío particular. Si bien los lineamientos para el tratamiento de estos pacientes se encuentran en las recomendaciones presentadas por la AAEEH, esta población requiere algunas consideraciones especiales. Es por ello que el Comité de expertos en hepatitis virales de la AAEEH ha decidido realizar las "Recomendaciones para el Tratamiento de la Hepatitis Crónica por Virus C en pacientes con enfermedad renal crónica, en diálisis (hemodiálisis y diálisis peritoneal) o trasplantados renales" en conjunto con la Sociedad Argentina de Nefrología (SAN), la Asociación Nefrológica de Buenos Aires (ANBA) y la Sociedad Argentina de Trasplantes (SAT). En estas recomendaciones se incluyen los últimos tratamientos recomendados, empleando los antivirales aprobados o en vías finales de aprobación por las autoridades regulatorias en nuestro país.
Estas recomendaciones están basadas en el análisis sistemático de la información relevante recientemente publicada. Las referencias se obtuvieron a través de una búsqueda informática en MEDLINE hasta agosto de 2018, de la revisión de las guías de práctica clínica de la AASLD, la EASL, la ALEH, la APASL y la OMS, de la revisión de las presentaciones en congresos internacionales, y de la experiencia publicada de líderes de opinión y expertos en el tratamiento de la hepatitis C. Para caracterizar la evidencia que sustenta cada afirmación, se le asignó a cada recomendación la Clase (reflejando beneficio versus riesgo) y el Nivel de Evidencia (evaluando potencia o certeza), según ha sido recomendado. Se recomendarán los esquemas de tratamiento que se apliquen a la mayoría de los pacientes.
Asumimos que el tratamiento de la hepatitis C con estas drogas debe ser indicado y monitoreado por profesionales altamente entrenados en este campo y que cuenten con el soporte tecnológico y multidisciplinario adecuados, en caso contrario, corremos el riesgo de desaprovechar las oportunidades terapéuticas y de no utilizar adecuadamente un recurso caro y limitado.
Citas
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