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Introduction When co-administered with interferon and ribavirin, the prescription drug telaprevir significantly improves treatment response in patients with chronic hepatitis C virus (HCV) infection. Its use, however, also increases the likelihood of adverse effects that may lead to discontinuation of treatment. Cutaneous adverse effects are particularly common. Objective To determine the frequency and clinical characteristics of drug eruptions induced by telaprevir in patients receiving HCV treatment and to analyze the clinical course of lesions and response to treatment. Material and methods We performed a prospective observational study of all patients who started a treatment regimen that included telaprevir between May 2012 and July 2013. We recorded the demographic characteristics of the patients who developed telaprevir-induced eruptions, and analyzed the clinical characteristics of the lesions and their clinical course following the application of guideline-based treatment recommendations. Results Twenty (46%) of the 43 patients who received triple therapy with interferon, ribavirin, and telaprevir during the study period developed drug reactions attributable to telaprevir. The reaction was classified as mild or moderate (grades 1 or 2) in 90% of cases and consisted of an exanthem with erythematous-edematous scaling plaques and papules. The rash worsened, mainly by spreading, in about one-third of cases. The skin lesions led to discontinuation of treatment in 2 patients (4.6%). Sustained viral response was achieved in 34 patients (79%). Conclusions Telaprevir-induced eruptions are common and often progress, but they rarely require patients to discontinue treatment.

Resumen Introduccion Telaprevir es un farmaco que administrado junto a interferon y ribavirina incrementa de forma significativa la respuesta al tratamiento de la infeccion por el virus de la hepatitis C. Sin embargo, su empleo incrementa tambien la probabilidad de desarrollar efectos adversos, en muchos casos cutaneos que pueden condicionar el mantenimiento del tratamiento. Objetivo Conocer la incidencia, caracteristicas clinicas y evolutivas y respuesta al tratamiento de las toxicodermias por telaprevir en el contexto del tratamiento de la infeccion por el virus de la hepatitis C. Material y metodos Estudio prospectivo observacional realizado entre mayo de 2012 y julio de 2013 en el que se incluyeron aquellos pacientes que iniciaron tratamiento con telaprevir durante ese periodo. En aquellos en los que se detectaron toxicodermia se recogieron los datos demograficos de los pacientes, las caracteristicas clinicas de las lesiones y la evolucion tras la aplicacion de las recomendaciones de las guias clinicas. Resultados De un total de 43 pacientes que recibieron tratamiento triple un 46% presento toxicodermia atribuible a telaprevir. En el 90% de los casos esta fue leve o moderada (grados 1 o 2) y consistio en un exantema constituido por papulas y placas eritematoedematosas y descamativas. En alrededor de un tercio de los pacientes se comprobo la progresion de la toxicodermia, principalmente en extension, durante el curso del tratamiento. En 2 casos (4,6%) las lesiones cutaneas condicionaron la suspension del farmaco. Un 79% de los tratados (34 pacientes) alcanzo una respuesta viral sostenida tras el tratamiento. Conclusiones Las toxicodermias asociadas a telaprevir son frecuentes en el curso del tratamiento y a menudo progresivas. Sin embargo, solo de forma excepcional condicionan su suspension.

Introduccion La hepatitis C es una de las causas mas frecuentes de enfermedad hepatica cronica en nuestro medio. La mayoria de los pacientes que presentan una infeccion aguda por el virus de la hepatitis C (VHC) desarrollan hepatitis cronica, y solo entre un 15 y un 30% se resuelven espontaneamente. Pacientes y metodo Se analizaron de forma retrospectiva las caracteristicas clinicas, biologicas y virales, asi como la tolerancia al tratamiento y el grado de repuesta sostenida, en 9 pacientes con hepatitis C aguda tratados con terapia combinada con interferon alfa mas ribavirina durante 12-48 semanas. Resultados La media de alaninaminotransferasa (ALT) y bilirrubina total de los pacientes en el momento del diagnostico fue de 1,469 U/l y 5,5 mg/dl, respectivamente. Todos los pacientes, excepto uno, estaban infectados por el genotipo 1b y presentaban una carga viral media de 634.924 U/ml. Al final del seguimiento, en 7 pacientes (77,7%) los valores de ARN-VHC fueron indetectables y los valores de ALT normales. La terapia fue bien tolerada excepto en 2 pacientes, uno de los cuales presento un sindrome depresivo leve que fue controlado con medicacion, y el otro una tiroiditis que obligo a la interrupcion del tratamiento a las 12 semanas. Conclusiones A pesar de ser una serie reducida de pacientes, el tratamiento combinado con inteferon alfa mas ribavirina parece conseguir una tasa de respuesta sostenida elevada, con una buena tolerancia y escasos efectos secundarios.

When co-administered with interferon and ribavirin, the prescription drug telaprevir significantly improves treatment response in patients with chronic hepatitis C virus (HCV) infection. Its use, however, also increases the likelihood of adverse effects that may lead to discontinuation of treatment. Cutaneous adverse effects are particularly common.To determine the frequency and clinical characteristics of drug eruptions induced by telaprevir in patients receiving HCV treatment and to analyze the clinical course of lesions and response to treatment.We performed a prospective observational study of all patients who started a treatment regimen that included telaprevir between May 2012 and July 2013. We recorded the demographic characteristics of the patients who developed telaprevir-induced eruptions, and analyzed the clinical characteristics of the lesions and their clinical course following the application of guideline-based treatment recommendations.Twenty (46%) of the 43 patients who received triple therapy with interferon, ribavirin, and telaprevir during the study period developed drug reactions attributable to telaprevir. The reaction was classified as mild or moderate (grades 1 or 2) in 90% of cases and consisted of an exanthem with erythematous-edematous scaling plaques and papules. The rash worsened, mainly by spreading, in about one-third of cases. The skin lesions led to discontinuation of treatment in 2 patients (4.6%). Sustained viral response was achieved in 34 patients (79%).Telaprevir-induced eruptions are common and often progress, but they rarely require patients to discontinue treatment.

983 INCIDENCE OF HEPATOCELLULAR CARCINOMA IN HCV MONOINFECTED AND HIV COINFECTED PATIENTS WHO RECEIVED ANTIVIRAL TREATMENT C. Leal Valdivieso, B. Revollo Barriga, I. Serra Matamala, R.M. Morillas Cunill, M. Sala Llinas, H. Masnou Ridaura, A. Bargallo Garcia, C. Tural Llacher, R. Planas Vila. Hepatology Unit, CIBERehd, Department of Gastroenterology, HIV Unit, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain E-mail: carles.leal@gmail.com