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Resumen Introduccion y objetivo La inclusion en practica real de los antivirales de accion directa en pacientes con hepatitis cronica por VHC ha supuesto un hito historico en Medicina. Pacientes y metodos Estudio analitico, prospectivo que incluyo 126 pacientes con hepatitis cronica por VHC tratados con antivirales de accion directa. Evaluamos la eficacia y seguridad del tratamiento y factores asociados a fracaso terapeutico. Resultados Edad 54 ± 10 anos. Varon (70%). Cirrosis (60%). Distribucion segun genotipos: G1a (31%), G1b (42%); G3 (14%); G4 (13%). Child-Pugh B y C (n = 15). Naive (56%). Tasa RVS fue (87,3%): Child-A (91%), Child-B (75%) y Child-C (60%). Las mejores tasas de curacion se alcanzaron con las combinaciones Combo 3D/2D ± ribavirina (RVS = 97,4%; n = 39) y sofosbuvir/ledipasvir ± ribavirina (RVS = 93,1%; n = 29). Tasas Discusion La presencia de genotipo 3, ascitis o dosis de ribavirina

Introduction and objective Inclusion of direct-acting antivirals into clinical practice in patients with chronic HCV (CHC) has been a milestone in medicine. Patients and methods Analytical, prospective study, involving 126 patients with chronic HCV treated with direct-acting antivirals. Efficacy and safety of treatment and factors associated with failure treatment were evaluated. Results Age 54 ± 10. Male (70%). Cirrhosis (60%). Distribution according to genotypes: G1a (31%), G1b (42%); G3 (14%); G4 (13%). Child–Pugh B and C (n = 15). Naive (56%). SVR rate was (87.3%): Child-A (91%), Child-B (75%) and Child-C (60%). The best cure rates were achieved with a 3D/2D ± ribavirin (SVR = 97.4%; n = 39) and sofosbuvir/ledipasvir ± ribavirin (RVS = 93.1%; n = 29) combination. An SVR rate of Discussion The presence of genotype 3, ascites or dosage of ribavirin 600 mg/day in cirrhotic G1 or G3, who will be treated with sofosbuvir + simeprevir or daclatasvir is recommended where no baseline resistance test is available.

Resumen Fundamento y objetivo Valorar el metabolismo basal y cinetico de las lipoproteinas durante el primer mes de biterapia en pacientes con hepatitis cronica C genotipo 1 (HCC-1). Pacientes y metodos Estudio longitudinal, prospectivo, que incluyo 99 pacientes HCC-1 naive , biopsiados y tratados con biterapia. Clasificamos a nuestros pacientes en 5 niveles de exigencia lipidica, segun el grado de fibrosis hepatica, carga viral basal y ratio de infectividad (cociente entre concentraciones medias de trigliceridos y colesterol unido a lipoproteinas de alta densidad durante el primer mes), estableciendo para cada uno de ellos, durante este periodo, una concentracion media minima necesaria de colesterol unido a lipoproteinas de baja densidad (colesterol LDL) para que el paciente alcanzara un «metabolismo lipidico favorable» (MLF), y valoramos su relacion con las tasas de curacion. Resultados Alcanzaron mayores tasas de curacion aquellos pacientes con fibrosis F3-F4 que presentaron mayores concentraciones basales de colesterol LDL, asi como aquellos que consiguieron mantener durante el primer mes de biterapia una ratio de infectividad menor de 3,2 y mayores concentraciones medias de colesterol LDL: media (DE) de 100 (23) mg/dl en «curados» frente a 89 (28) mg/dl en «no curados», odds ratio 1,1, intervalo de confianza del 95% (1,0-1,2) (p Conclusiones No todos los pacientes con HCC-1 van a presentar durante el primer mes de tratamiento una cinetica lipidica favorable, siendo necesario para curarse y/o alcanzar un MLF mantener durante este periodo unas concentraciones plasmaticas medias de colesterol LDL mayores. Aquellos con ausencia de un MLF podrian beneficiarse del uso de estatinas.

Background and objective We analysed baseline and kinetic characteristics of lipid metabolism during the first month of bitherapy in patients with chronic hepatitis C genotype 1 (CHC-1). Patients and methods A longitudinal, prospective study including 99 naive CHC-1 patients with liver biopsy who were treated with bitherapy. Our patients were assigned to one of the 5 different “degrees of lipid requirement” that we established depending on the degree of liver fibrosis, baseline viral load and infectivity ratio (ratio between the median level of triglycerides and high density lipoproteins-cholesterol during the first month). The goal was to achieve “a favourable lipid metabolism” (FLM) by establishing a necessary minimum level of low density lipoproteins (LDL)-cholesterol during this period for each one of them. We also analysed the relationship with the rate of sustained virological response. Results Patients with liver fibrosis F3-F4 who had higher baseline levels of LDL-cholesterol achieved higher rates of sustained virological response. Those patients who had a lower value of infectivity ratio and median levels of LDL-cholesterol during the first month of bitherapy also achieved higher rates of sustained virological response: SVR group 100 (23) mg/dl against non-SVR group: 89 (28) mg/dl; odds ratio 1.1; 95% confidence interval (1.0–1.2); P P = 0.013). Patients with sustained virological response had higher rates of FLM. Conclusions Not every patient with CHC-1 has the same lipid kinetics during the first month of bitherapy, and it is necessary to achieve a sustained virological response and/or a FLM to keep higher plasma levels of LDL-cholesterol during this period. Those subjects without FLM could benefit from statins.