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hepatitis c_part2

92 | Hướng dẫn viêm gan C ngưng. Các khuyến cáo điều trị hiện tại châu Âu khởi PEG-INF và ribavirin cho HIV / bệnh nhân đồng nhiễm HCV đang Thể hiện trong hình 8.1. Bảng 8.3 - Thủ tục chẩn đoán viêm gan C trong đồng nhiễm HIV (chuyển thể từ Rockstroh năm 2008). | 92 Hepatitis C Guide discontinued. The current European recommendations for treatment initiation of PEG-INF and ribavirin for HIV HCV coinfected patients are shown in Figure 8.1. Table 8.3 - Diagnostic procedures for hepatitis C in HIV coinfection adapted from Rockstroh 2008 . Diagnosis of hepatitis C HCV Ab positive 1-5 months after infection may rarely be lost with immunosuppression HCV RNA level while not prognostic for progression it is for response to treatment Status of liver damage Grading of fibrosis e.g. Fibroscan liver biopsy serum fibromarkers Hepatic synthetic function e.g. coagulation protein albumin CHE Ultrasound and AFP every 6 months in cirrhotic patients gastroscopy upon diagnosis of cirrhosis and every 1-2 years thereafter Before HCV treatment HCV genotype and serum HCV RNA Auto-antibodies ANA SMA ANCA and LKM1 TSH thyroid autoantibodies if applicable Monitoring of HCV treatment Differential blood count and liver enzymes every 2-4 weeks HCV RNA at week 4 to evaluate rapid virological response week 12 24 48 72 if applicable and 24 weeks after stopping HCV therapy CD4 count every 12 weeks TSH every 12 weeks Low viral load defined as less than 400 000 IU L when using PEG-IFN RBV there is no standard conversion formula for converting the amount of HCV RNA in copies ml to the amount reported in IU. The conversion factor ranges between one and five HCV RNA copies per IU. Serum fibromarkers include APRI FIB-4 hyaluronic acid Fibrometer Fibrotest Forns Hepascore and other indices recently more complex tests such as Fibrometer Fibrotest and Hepascore have shown more accuracy in predicting liver fibrosis than simple biochemical tests such as APRI FIB-4 or Forns. Patients with positive anti-LKM or -ANA with homogeneous pattern should be evaluated for concurrent autoimmune hepatitis especially in the presence of ALT elevation while on treatment. This is trial version www.adultpdf.com 8. Management of HCV HIV Coinfection 93 Table 8.4 - Classification of and .