Phác đồ mới điều trị viêm gan siêu vi C

Phac do mdi dieu tri

-fr OS. HUYNH VAN NHIEM

Vifim gan sifiu vi C (gpi tit id vifim gan C) la

mpt bfnh do virus lan truyen kha rfng rdi,

vdi trfin 150 trifiu ngfldi trfin todn d u mie

phai (theo fldc tinh cija To chflc Y te The' gidi).

Virus gdy bfinh vifim gan sifiu vi C (HCV) dfldc phat

hifn tfl nam 1989. Virus ndy Idy qua dfldng mau, nhfl

vifim gan sifiu vi B (HBV), nhimg it khi lay qua dfldng

tanh due hogc dfldng me truyin cho con khi sinh.

Vifim gan C dflde xem Id mpt bfinh tham lang.

Trong 6 thang dau sau khi nhiem, da sd bfinh nhan

khfing ed trifu ehflng nfin khfing bilt minh da hi

nhiem, chi cd khoang 1/3 sfi' ngfl&i mac bfnh ed bilu

hifn vdi nhiing trifiu ehiing thfldng nhe. Vife khdng

cd trieu chting cd the keo dai nhieu ndm trong khi

dd virus vin tifi'p tuc sinh sfii nay nd trong gan. Ne'u

sau 6 thang ma ed the ngfldi hi nhiem khdng tfl difit

dfldc virus HCV, thi bfnh se hiln thanh man tfnh

r i t khd ehfla tri. Mpt sl ngfl&i hi vifim gan C man

tfnh cd the thay mft mdi, khd tap trung, lo ling hay

chan nan, ngfl&i giy yfi'u, dau eo hay dau khdp. Xet

nghiem mdu trong thdi ky nay thd'y tang ndng do cua

cac men gan AST vd ALT.

Kfi't qua la khoang 20% bfnh nhan vifim gan C ton

thflcfng gan (gpi la xd hda) ed the lan rdng, dan de'n

xd gan khfing th i tri bet, trfl khi phai ghep gan. Mft

sd' trfldng hop ehuyin thdnh ung thfl gan.

Virus viem gem C ed 6 kiiu gen (genotype) chfnh:

- Kiiu gen 1 (gom la va lb) Id kieu gen pho biln

nha't tren th i gidi, vdi hdn 83 trifiu bfnh nhdn hi

nhiim, trong dd mfit phin ba efl tru trong khu vfle

Ddng A.

- Kiiu gen 2 vd 3 d chdu Au, Bac My, chdu tJc vd

vung Vien Ddng.

- Kiiu gen 4 thfl&ng gap d Trung Ddng va chdu Phi

- Kiiu gen 5 vd 6 hie'm hdn.

Cac kieu gen can dfldc xdc dinh bdng xet nghifm

mdu trfldc khi bit dau dieu tri, vi cd mdt so' kilu gen

khd dieu tri hcfn nhiing kieu gen khac.

O Viet Nam da sl bfnh nhan viem gan C thufc

kieu gen 1 va la kieu gen khd tri nhat.

Cho din gan day, tieu ehuan dieu tri cho viem gan

C man tinh kilu gen 1 gim sfl kfi't hpp cua ba logi

thuoe: ribavirin (IffiV), pegylated interferon (PEG) va

mfit chat flc chl enzym protease (nhfl boceprevir hode

telaprevir). Phac dd dieu tri nay kha phflc tgp, gom

ca thud'c tifim vd thuoc ufi'ng, cd the phai ud'ng de'n

18 vien mli ngdy va keo ddi tdi gan 1 nam, ma ty

If thdnh cfing lai thd'p (dfldi 50%). Ngoai ra, nhQ'ng

THUOC & StfC KHOE so 507 (1.9.2014)

thudc ndy ed the gay ra nhilu tde dung phu nghifim

trpng, khiln nhieu ngfldi khfing the dung dfldc hogc

phai bd tri.

Mdi ddy, theo kfi't qua eua hai cufie nghien cflu

dfldc edng b l tren tgp ehi The Lancet vdo culi thdng

7.2014, d c nhd ngliien cflu dd dung mpt sfi' thuoc ed

tdc dung tnie tifi'p (direct-acting antiuirals gpi tit Id

DAA) chi hodn todn Id thuoc ufi'ng, dd chflng td dflpc

nhiing hifiu qud vfldt trpi so vdi cdc phdc dl cu.

Trong nghien cijfij thfl 1 mang ten HALLMARK￾DUAL giai doan 3, GS. Michael Manns tfl Trfldng Y

khoa Hannover d Dflc vd ede dong nghifp phdn ngau

nhifin 645 bfnh nhan cd HCV kieu gen lb tfl 18 qufi'c

gia de dieu tri 6 thang vdi 2 thufi'e BAA la unaprevir

vk daclatasvir, 102 henh nhdn khac dilu tri gia dfldc

(placebo) lkm nhdm dfi'i ehung.

Phdc do dieu tri nay cd hieu qua cao vd dung ngp

tit, ngay ea d nhiJng benh nhdn vd'n khd dieu tri

nha't. Ke't qua la lam sgch virus d 90% bfnh nhdn

trfldc dd khdng dflpe dilu tri vd 82% nhiing ngfldi dd

dilu tri theo phdc dl cu, nhiing khfing dung nap hoac

khong thanh cdng

Theo GS. Manns, "hifu qua va an toan cua phde

do gom daclatasvir va asunaprevir trong 24 tuin

dai difn cho mdt cai tie'n ldn trfin thfi' hf diu tien

cua chit flc ehe' protease so vdi phflpng phdp dilu tri

cu. Phac do dieu tri mdi nay hoan todn dijng dfldng

uong, khfing cd interferon va ribavirin, cd hieu qua

hdn, an toan hem, ngan ngdy va ddn gian hdn, ca

cho nhij'ng bfnh nhdn khd chfla tri nhfl dd hi xd gan,

hoac cho nhflng ngfl&i da khfing dap flng vdi cae lifu

phap trfldc day. IS