các bài tham luận tại hội nghị y khoa quốc tế

1. HỘI NGHỊ GAN MẬT HOA KỲ LẦN THỨ 53 (AASLD Boston 1 - 5/11/2002)

CLINICAL RESEARCH ON THE TREATMENT OF CHRONIC HEPATITIS B WITH THYMOSIN- a1 AND LAMIVUDINE VERSUS INTERFERON-α AND LAMIVUDINE

Dr. Pham Thi Thu Thuy
Head of Hepatology Dep. –Medical Medic Center-HCM City

 Thymosin-α1 with lamivudine may be more effective than IFN-α with lamivudine .Compared with IFN-a and Lamivudine , Thymosin a1   and Lamivudine are better tolerated and seem to induce a gradual and more sustained ALT normalization and HBVDNA loss .However such results need to be confirmed with a randomized double blind study with larger number of patients in the future.

Abstract 1843- Hepatology Vol 36 N 4

 

2. HỘI NGHỊ TIÊU HÓA THẾ GIỚI ( WCOG) Bangkok – Thailand - 24/2 - 1/3/2002

 

Poster :

RELATION BETWEEN DIABETES AND HCV INFECTION 

Dr.Pham Thi Thu Thuy
MEDIC MEDICAL CENTER

The association of diabetes mellitus with chronic liver disease, particularly cirrhosis, was recognized many years ago. Preliminary studies suggest that hepatitis C virus (HCV) infection may be an additional risk factor for the development of diabetes mellitus .To further study the correlation of HCV infection and diabetes, we performed a retrospective analysis of 7234 patients with vial hepatitis and analyzed whether age,sex, hepatitis B virus (HBV) infection, HCV infection, and cirrhosis were independently association with diabetes. Second a case-control study was conducted to determine the seroprevalence of HCV infection in a cohort of 641 diabetic patients . Diabetes was observed in 11.51% of HCV –infected patients compared with 5.18% of HBV –infected patients .The older the age is  the higher the prevalence of diabetes mellitus is . In the diabetes cohort , 36.36% were found to be infected with HCV compared with 4% of control patients. HCV serotype 2 was observed in 36.36% of HCV-RNA -positive  diabetic patients vesus 10.52% of HCV-infected control . In conclusion ,the data  suggest a relatively strong association between HCV infection diabetes, because diabetes have an increased frequency of HCV infection , particularly with serotype 2 .Furthermore , it is possible that HCV infection may serve as an additional risk factor for development of diabetes, beyond that , attributes chronic liver disease alone.

3. HỘI NGHỊ GAN MẬT CHÂU Á –THÁI BÌNH DƯƠNG (APASL) Bali - Indonesia- 18 - 21/8/2005

Poster 327

Prevalence of HCV genotypes in Vietnam

                                                                        Thu Thuy -Tan Dat- Thanh Tong- BaoToan -  Ba Tong- Oanh- Trang
                                                            MEDIC Medical Centre, HCM City, Viet Nam

 

Background:
HCV genotypes are distributed differently depending on geography and  etiology of infection. We studied the spectrum of HCV genotypes in chronic liver Vietnamese patients. The incidence of Hepatitis C (HCV) isolates found in clinical practice is of great clinical significance to the treatment of HCV infected patients as different subtypes may respond unequally to therapy. Beside, both viral load and HCV genotype may have relevance in chronically infected

Objectives:      To evaluate the prevalence of HCV genotypes in Vietnamese patients.
Comparison of serum virus loads among Patients infected with Hepatitis C Virus (HCV) genotypes 1, 2 and 6

Methods:        A total of 202 HCV RNA positive patients with chronic hepatitis were enrolled (Male 59,4%, female 40,6% with mean age of patients 47,89 ± 10,87 years
) from April 2004 to Nov 2004. At the same time, we collected 149 random serums in this group to perform Branched DNA for quantitative HCVRNA.
All samples were amplified RT – PCR (In-house PCR amplification   with NP & OP primer from Bayer Corporation) in the 5’ UT region. Biotinylated amplicon, generated by PCR of HCVRNA is hybridized  to immobilized probes. The probes, which are bound to a nitrocellulose strip by a poly (T) tail, are specific for the 5’ UT of the different HCV genotypes (The versant HCV Genotype Assay, Bayer).
Statistical analysis: SPSS for Window 7.5 software. The data were expressed as percent, mean±SD. Chi-square test was used to analyze the discontinuous variables.

Results:
Genotypes 1 and 6 were the commonest genotypes, followed by type 2 and the rare genotype 3 in alone patient. Genotype 1 was seen in 58,9% (Type 1: 6,9%; 1a: 6,9%; 1a/1b: 0,5%; 1b: 44,6%) while genotype 6a in 25,2%, genotype 2 in 11,4% (type 2: 2%; type 2a/2c: 9,4%) and genotype 3b was 0,5%, eight samples (4%) were unclassified. Then we performed sequencing based on 5’UT with Trugene system identified genotype 1 (1 case), 1b (2 cases), 6a (5 cases) but not typed by LiPA. 149 patients had viral loads above 3200 copies/ml (Range: 4000 - > 40,000,000 copies/ml, with 5,18x10­6 ±
6.53x10­6 copies/ml.
). HCV genotype 1, 2, 6 had quantity HCV RNA above 2x106 copies/ml was 55, 10, 23 cases, and below 2x10­6 copies/ml was 32, 9, 20 cases, respectively. We observed no significant difference in virus load between patients infected with genotype 1, 2, 6.(P>0,05)

Conclusions:
Our study indicated that HCV genotypes 1 and 6 are common in Viet Nam. With subtype 1b is the most common. A unique genotype 3b was detected in our patients. There isn’t relationship between HCV genotype and viremia levels. The TruGene system, a direct sequencing method, is more efficient in the identification of HCV genotype.

Liver International Hepatology 2005- Abstract book

4. HỘI NGHỊ TIÊU HÓA THẾ GIỚI (WCOG) Montreal – Canada - 12 - 14/9/2005

President poster: PP7

Clinical research on the treatment of chronic hepatitis B with thymosin- a1 and lamivudine versus interferon-α and lamivudine

Pham Thi Thu Thuy - Ho Tan Dat
Medic Medical Center-HCM City

It has recently been shown that thymisin-a 1, a synthetic polypeptide of thymic origin, an immune modifier, is able to promote disease remission and inhibition of hepatitis B virus replication. We evaluated the efficacy and safety of thymosin- a1 and lamivudine treatment compared with interferon -a and lamivudine treatment on the patients with chronic hepatitis B who were difficult to be treated well, failed to lamivudine treatment alone. Eighty three patients (Age: 18-60) with confirmed chronic hepatitis B and positive for HBV DNA with an elevated ALT of at least two times normal who failed to lamivudine treatment alone were entered into this study. Eighty three patients were randomly assigned to receive either thymosin- a1  1.6mg SC twice weekly and lamivudine 100mg p.o daily or 5MU of interferon-a three times weekly and lamivudine 100mg p.o daily for 6 months. At the end of treatment, complete response (defined as ALT normalization and HBVDNA loss) occurred in 11 of 43 (25.58%) in group I and in 22 of 40( 55%) in group II (p<0.01) . After a follow up period of 6 months, a complete response was observed in 18 of 43 (41.86%) in group I and 19 of 40 (47.50%) in group II (p>0.05)  . After a follow up period of 12 months, a complete response was observed in 25 of 43 (58.14 %) in  group I and 12 of 40 (30%) in group II  (p<0.05)  .  So thymosin- a1   with lamivudine may be more effective than interferon-a and lamivudine by immunomodulatory effect. Compared with interferon-a and lamivudine, thymosin- a1   and lamivudine are better tolerated and seem to induce a gradual and more sustained ALT normalization and HBVDNA loss. Unlike interferon-a , thymosin- a1   was well tolerated by all patients. The side effect of thymosin- a1  group was rare .The better response was in HbeAg-negative and HBVDNA- positive patients. However such results need to be confirmed with a randomized double blind study with larger number of patients in the future.

5. HỘI NGHỊ GAN MẬT THẾ GIỚI Cairo- Ai Cập – 7—11/9/2006

Poster 114

Applying Sequencing To Identify Hepatitis B Virus Genotypes And Mutations

 

Ho Tan Dat, Pham Thi Thu Thuy,
Nguyen Bao Toan, Nguyen Thanh Tong
MEDIC Medical Center –Ho Chi Minh City-VietNam

Hepatitis B Virus (HBV) can be classified into 8 genotypes A through H based on an intergroup divergence of 8% or more in the complete nucleotide sequence, and the different distribution of various genotypes in different continents, countries. The identification of HBV genotypes are more concerned as it is HBV genotypes relating to clinical manifestation, activity of liver disease as well as treatment responses of Hepatitis B. Additionally, the discovery of resistance to medicines in HBV treatment plays a very important role from which we can have an appropriate and effective choice in Hepatitis B treatment. We have applied the Sequencing by TruGene (Bayer) to identify Hepatitis B Virus Genotypes and Mutations. From August 2004 to November 2005, in MEDIC laboratory, we have implemented sequencing for 69 cases Vietnamese with Chronic Hepatitis B on Lamivudine treatment in which: 55 cases are males (take 79.7%) and 14 cases are females (take 20.3%), medium age: 34.6±10.3. All cases are HBVDNA (+) in which: 50 cases are HbeAg (+) (72.5%) and 19 cases are HbeAg(-) (27.5%). There are only two genotypes of HBV: genotype B and genotype C, in which 45 cases are genotypes B (65.2%) and 24 cases are genotype C (34.8%).

Totally there are 41 cases (59.4%) mutations with following established proportion and types: L180M (5.8%); L180M & M204I (8.7%); L180M & M204V (30.4%); L180M, M204V & V207I (1.4%); M204I (8.7%); M204I&V207I (1.4%); M204V (2.9%).
There are 25 cases mutations in 45 cases of genotypes B (55.6%) and 16 cases in 24 cases of genotypes C (66.7%). All patients are on Lamivudine treatment with average time is 2.4±0.9 years, the corresponding number of patients in treatment period of 1,2,3,4 year are 10, 29, 21, 9. The proportion of developing mutations after 1, 2, 3, 4 years of treatment with Lamivudine is 20%; 55.2%; 76.2%; 77.8%.

We have found that – with above preliminary results – the sequencing plays a very important role in identifying Hepatitis B Virus Genotypes and Mutations. From those results we can approach an optimal treatment course.


Liver International Vol 26-Supp 1

 

6. HỘI NGHỊ GAN MẬT CHÂU Á- THÁI BÌNH DƯƠNG (APASL) Kyoto - Japan - 26 - 30/3/2007


Poster 0411: được giải Best Poster
COMPARISON BETWEEN THE TWO PEGINTERFERONS ALFA IN THE TREATMENT OF CHRONIC HEPATITIS C

Dr.Pham Thi Thu Thuy
Dr.Ho Tan Dat
Medic Medical Center-HCM City

 

In order to have the evaluation of efficacy, safety and to detect the predictors for sustained viral response of two  Peginterferons, we have implemented a matched pair study on treatment naïve chronic hepatitis C patients treated with weight –based Peginterferon  alfa -2b or fixed dose  Peginterferon alfa- 2a plus Ribavirin.
There are 211 naïve chronic hepatitis C patients aged from 18 to 68, divided into two equal groups in clinical manifestations. Group I ( N=116; 67 genotype 1, 15 genotype 2, 34 genotype 6) were treated with  Peg-IFN alfa-2b, 1.5mcg/kg qweek plus Ribavirin 15mg/kg/day; Group II ( N=95; 56 genotype 1, 11 genotype 2, 28 genotype 6) were treated with  peg-IFN alfa-2a 180mcg/week plus Ribavirin 15mg/kg/ day. The time of treatment was 48 weeks. Sustained viral response was undetectable HCVRNA after 24 weeks of follow-up. The treatment outcome can be predicted by analyzing various data on age, sex, weight, serum ALT, genotype and virus load.  The sustained viral response rate of Group I was not different from of GroupII on total patients ( 62.06% vs. 61.05%, p>0.05) . The relapse in two groups were also similar (19.10% vs. 19.44%, p>0.05). The sustained viral response with treatment of Peg-IFN alfa-2b was better than with Peg-IFN alfa- 2a in group of high-weighed patients ( 28.57% vs. 61.9%, p<0.01). Baseline ALT, age, sex, genotype, virus load were not statistically significant predictors of sustained viral response between two Peginterferons .
In conclusion, the sustained viral response rate is similar in naïve chronic hepatitis C patients treated with Peg-IFN alfa-2a or Peg-IFN alfa-2b.Peg-IFN alfa-2b seems to be better in high-weighed patients. Side effect of thrombocytopenia more frequently occurs in treatment with Peg-IFN alfa-2a, however it should be further studied in future.

International Hepatology 2007-Vol1-N1

 

 

7. HỘI NGHỊ GAN MẬT HOA KỲ LẦN THỨ 58 (AASLD) Boston 2 - 6/11/2007

Poster 332

COMPARISON BETWEEN THE TWO PEGINTERFERONS ALFA IN THE TREATMENT OF CHRONIC HEPATITIS C

Dr.Pham Thi Thu Thuy
Dr.Ho Tan Dat
Medic Medical Center-HCM City

Abstract 332, Hepatology Vol 46, N 4


8. HỘI NGHỊ GAN MẬT CHÂU Á –THÁI BÌNH DƯƠNG (APASL) Hongkong 13 - 17/2/2009

Presentation: FP 053

PEGYLATED INTERFERON ALFA-2a PLUS RIBAVIRIN IN CHRONIC HEPATITIS C PATIENTS WITH GENOTYPE 6

DR. Pham Thi Thu Thuy
DR. Ho Tan Dat
Medic Medical Center- HCM City-VN

Aims: The effectiveness of the combined treatment Peginterferon alfa -2a and ribavirin in Hepatitis C were intensively studied, but mainly for genotype 1. Little information was known about the treatment of genotype 6 which occurred at high frequency in several Asian countries, including China, Viet Nam, Hongkong and Thailand etc. The aims of the study therefore are to evaluate the effectiveness, safety and other influential factors at the therapeutic regime of Peginterferon alfa -2a combined with Ribavirin for chronic hepatitis C patients with genotype 6 in Vietnam.
Patients and methods:  75 chronic hepatitis C patients with genotype 6 were classified into two groups. Group I included 42 naïve patients, group II included 33 patients who had previously failed with standard Interferon –alfa. All the patients were treated with Peginterferon alfa-2a 180mcg/w combined with Ribavirin 15mg/kg/day; the period of treatment time was 48 weeks. Sustained viral response was defined as undetectable HCVRNA after 24 weeks of follow-up. Ages, sexes, increase of ALT, AST/ALT ratio and viral load were the factors for evaluating the effectiveness of the treatment and the prognosis.
Results: Sustained virus responses were nearly the same between the two groups (Group I: 69.04%; Group II: 60.60%; p>0.05). Normal transaminase levels at week 72 were 73.80%, 63.63% in group I and group II, respectively. It was found that  younger  patients , AST/ALT ratio lower than 1 were the factors that could induce a higher sustained  viral response in every group. Viral load only affected to sustained viral response in patients were  previous treatment failed . Patients who had rapid viral responses, almost all had sustained viral responses.
Conclusion: Patients with chronic hepatitis C genotype 6 who have never been treated or have failed with standard interferon showed good responses when treated by Peginterferon alfa-2a combined with Ribavirin . The sustained viral response was better than that of genotype 1.  Patients especially had rapid viral responses; almost all had sustained viral responses. So will the treatment time be shorten for these patients? We will need further studies in future.

International Hepatology- 2009- Vol 3-N 1

Poster E058

ENTECAVIR FOR TREATMENT OF LAMIVUDINE –REFRACTORY   PATIENTS CHRONIC HEPATITIS B

Dr.PHAM THI THU THUY
Dr.HO TAN DAT
MEDIC MEDICAL CENTER-HCM CITY

 

Lamivudine treatment is associated with frequent development of resistant hepatitis B virus. This incidence especially is higher in the longer time of treatment and loss of treatment benefit. Entercavir is a new antiviral agent shown its high efficacy even in cases of mutations with Lamivudine resistance. In this study, we would like to evaluate the efficacy, the safety of Entercavir in treatment of Lamivudine-refractory patients chronic hepatitis B. To analyze factors that influent to the efficacy of treatment.
Sixty chronic hepatitis B patients with evidence of Lamivudine resistance were randomly divided into two groups in proportion of 3:1. Group I (n=45) used Entecavir 1mg/day, group II (n=15) used Lamivudine 100mg/day. Treatment time was 48 weeks. All data were evaluated in the end of the treatment: histology, ALT, HBVDNA. The factors such as: age, sex, ALT, HBVDNA, genotype, HBeAg were analyzed to evaluate their influences to the treatment.
The results have showed HBVDNA<2000 copies/mL in Entecavir group 37.78% vs. 0% Lamivudine group (p<0.01). HBVDNA negative in Entecavir group was 17.77% and incidence of seroconversion of HBeAg was 8.82%. ALT was normal in Entecavir group 77.77% vs. 26.66% in Lamivudine group (p<0.001).Histologic improvement in Entecavir group was 37.77% vs.6.66% in Lamivudine group (p<0.05). Patients with HBeAg negative, genotype B, low virus load were shown better results.
Entecavir was shown to be efficacious in the treatment for chronic hepatitis B patients experienced with Lamivudine resistance. Entercavir is safe, with almost no side effects. Factors such as HBeAg negative, genotype B, low virus load seems to be better in response to the treatment. The recurrence or mutation of Entecavir resistance should be studied further in future. 

International Hepatology- 2009- Vol 3-N 1  

9. HỘI NGHỊ TIÊU HÓA HOA KY (DDW) Chicago 29/5 - 5/6/2009

Poster M 1795

PEGYLATED INTERFERON ALFA-2a PLUS RIBAVIRIN IN CHRONIC HEPATITIS C PATIENTS WITH GENOTYPE 6

DR. Pham Thi Thu Thuy
DR. Ho Tan Dat
Medic Medical Center- HCM City-VN

10. HỘI NGHỊ TIÊU HÓA THẾ GIỚI (WCOG) London 21 - 28/11/2009

Poster 1978

PEG-INTERFERON ALFA-2a AND RIBAVIRIN IN PATIENTS WITH CHRONIC HEPATITIS C WHO HAVE FAILED PRIOR TREATMENT
Dr.Pham Thi Thu Thuy
Dr.Ho Tan Dat
Medic Medical Center

Summary:

Aims: Chronic hepatitis C patients who were treated with Interferon alfa afterward having a failure of therapy or relapse are not very few. So, a question that if these cases could be retreated with Peginterferon-alfa? The aims of the study are to evaluate the effectiveness, safety and other influenced factors to the therapeutic regime of Peginterferon alfa-2a combined with Ribavirin.
Patients and Methods:  117 chronic hepatitis C patients were classified into two groups. Group I consisted of 63 patients who were previously failed with interferon –alfa, of those including HCV genotype 1 (n=41), genotype 2 (n=7) and genotype 6 (n=15). Group II included 54 patients who had a relapse after stopping treatment, involving HCV genotype 1 (n=40), genotype 2 (n=5) and genotype 6 (n=9). All the patients were retreated with Peginterferon alfa-2a 180mcg/week combined with Ribavirin 15mg/kg/day, period of treatment time were 48 weeks. Sustained viral response was defined as undetectable HCVRNA after 24 weeks of follow-up. Ages, sex, AST/ALT ratio, HCV genotype, viral load, previously treated with interferon alone or combined with Ribavirin were the factors for evaluating the effectiveness of treatment and prognosis.
Results: The results were found that: Sustained viral response was significantly higher in the relapsed group than that in the non-respond group (44.44 % vs. 26.98 %, p<0.05), in particular in patients with genotype 1. The rate of relapse in non-respond group was also higher than that in the relapsed group. We found that younger patients, without HCV genotype 1, AST/ALT ratio lower than 1, previously treated with interferon alone were the factors that could induce a higher sustained viral response in every group. Viral load only affected to sustained viral response in non-respond group. Dose reduction of Peginterferon or Ribavirin do not cause any influences on sustained viral response.
Conclusions: In chronic hepatitis C patients with difficulties of treatment, non-response or relapsed with previous therapy of interferon alfa still being able to gain a sustained viral response when retreated with Peginterferon alfa-2a plus Ribavirin. Relapsed patients or previously treated with interferon alone could have a successful potential of retreatment. Dose reduction of Peginterferon or Ribavirin does not cause any influences on sustained viral response.

An International of journal of Gastroenterology and Hepatology – November 2009- Vol 58- Supp II

11. HỘI NGHỊ GAN MẬT CHÂU Á-THÁI BÌNH DƯƠNG
BẮC KINH –TRUNG QUỐC- 24/3-----28/03/2010

Preaentation : FP 100

AN OPTIMAL DURATION OF TREATMENT FOR CHRONIC HEPATITIS C GENOTYPE 1 PATIENTS

Dr. Pham Thi Thu Thuy
Dr. Ho Tan Dat
Medic Medical Center-HCM City

Summary:
Aims: Combination of peginterferon with ribavirin in treatment for  chronic hepatitis C genotype 1 in 48 weeks was shown to have rather high relapse rate. There are different opinions on treatment course, it’s considered that longer treatment course being better outcomes. The aims of the study therefore are to compare the effectiveness between the standard course of treatment (48 weeks) and prolong course (72 weeks). We will consider which factors leading to predict the sustained virologic response.

Patients and methods: 108 hepatitis C patients with genotype 1 were classified into two groups. Group I included 63 patients who received 48 weeks of  treatment. Group II included 45 patients received 72 weeks of  treatment. All the patients were treated with Peginterferon alfa-2a 180mcg/week  combined with Ribavirin 15 mcg/kg/day.  Ages, sex, increase of ALT, rate of rapid virological response, viral load were the factors for evaluating the effectiveness of the treatment and the prognosis.

Results: sustained virological response in group II were higher than in Group I (84.44% vs. 55.55%, p<0.01). Patients in group II who became negative for HCVRNA between weeks 12 and 24 had significantly  higher SVR rate than that of group I (54.54% vs. 6.66%, p<0.001). Factors associated with an SVR include younger age, an AST/ALT ratio lower than 1, FibroScan from F1 to F3 and lower viral load in group I. In group II, oly age impact on SVR. SVR rates were highest in those patients which achieved an RVR.
Conclusion: Patients with chronic hepatitis C genotype 1 who were treated by peginterferon alfa combined with Ribavirin in 72 weeks extended  treatment shown higher sustained viral response than those in 48 weeks. RVR was a very strong predictor of SVR. The patients with late viral negativity for HCVRNA should be treated for 72 weeks. No serious adverse events or withdrawals for safety reasons were seen in both treatment regimens.

Hepatology International  2010 –Vol 40 –N1-FP 100

12. HỘI NGHỊ CHUYÊN SÂU NGHIÊN CỨU VIÊM GAN CHÂU Á- THÁI BÌNH DƯƠNG LẦN THỨ I - APPH 2011- TP HCM- 18-19/06/2011

An optimal duration of treatment for chronic hepatitis C genotype 6 patients

Dr. PHAM THI THU THUY
Dr. HO TAN DAT
MEDIC MEDICAL CENTER-HCM CITY

Optimal duration of the combined treatment of peginterferon alfa-2a and ribavirin (Peg-IFN/RBV) in chronic hepatitis C has been intensively studied for genotypes 1, 2 and 3. In contrast little information is known about the optimal duration of therapy for patients with HCV genotype 6.  At present, guidelines state that Asian G6 patients should undergo 48 weeks’ treatment with Peg-IFN/RBV;1 however, more recent data suggest that 24 weeks’ treatment may be as effective,2,3 hence there is a need for further studies to confirm optimal treatment duration in this population.

During this presentation one such study will be discussed. The aim of the study was to compare efficacy between a standard course of treatment of 48 weeks (group 1) and a shorter duration of treatment of 24 weeks (group 2). Baseline and on-treatment factors were also assessed for their effect on SVR. SVR results were similar between the two groups (79.36% in group 1 versus 72.41% in group 2, p>0.05) suggesting that efficacy is not compromised by a shortened treatment duration. Patients who were younger in age and had an AST/ALT ratio lower than 1 were found to achieve higher SVR rates in both treatment groups. Degree of fibrosis and viral load only affected SVR in patients who received the shortened treatment duration of 24 weeks. Achieving an RVR was highly indicative of achieving an SVR especially in patients treated for 24 weeks.

In conclusion, patients with chronic hepatitis C genotype 6 treated with Peg-IFN/RBV for 24 weeks versus 48 weeks achieved similar SVR rates. RVR was a very strong predictor of SVR regardless of treatment duration however patients that did not achieve RVR should be treated for 48 weeks.

1. Antaki N, et al. Liver Int 2010; 30: 342
2. Lam KD, et al. Hepatology 2010; 52: 1573
3. Zhou YQ, et al. J Viral Hepat 2010; Epub ahead of print

13.HỘI NGHỊ GAN MẬT HOA KỲ- AASLD- SAN FRANCISCO- 4/11—8/11/2011

Poster 958

AN OPTIMAL DURATION OF TREATMENT FOR CHRONIC HEPATITIS C GENOTYPE 6 PATIENTS

Dr. Pham Thi Thu Thuy
Dr. Ho Tan Dat
Medic Medical Center- Ho Chi Minh City- Viet Nam

Hepatology –V 54, N 4 (Suppl) October 2011- Abstract 958

14. HÔI NGHỊ GAN MẬT CHÂU Á-THÁI BÌNH DƯƠNG 16/-2- 19/02/2012

Poster PP12-027

PREVALENCE OF HCV GENOTYPES IN VIETNAMESE PATIENTS AT MEDIC MEDICAL CENTER, VIET NAM

Dr. Ho Tan Dat, Dr. Nguyen Bao Toan, Dr. Vu Duc Anh, Dr. Pham Thi Thu Thuy.
MEDIC Medical Center, Ho Chi Minh City, Viet Nam.

Background:
Hepatitis C Virus (HCV) genotypes are distributed differently depending on geography and etiology of infection. The incidence of HCV isolates found in clinical practice is of great clinical significance to the treatment of HCV infected patients. The aim of this study was to identify the HCV genotypes in Vietnamese patients at MEDIC medical center, Ho Chi Minh City.
Methods:
A total of 3686 HCVRNA positive patients with chronic hepatitis C were enrolled (Male 48.86%, female 51.14% with mean age of patients 49.20 ± 11.48 years)  from January 2007 to August 2011.
We have performed the sequencing of the 5' non-coding of the hepatitis C virus genome collected from sera with HCVRNA positive. To carry out the sequencing, first the sera must be extracted to collect the total RNA, and then the RNA must be reverse transcripted into cDNA by Random primers. The PCR using specific primers targeted the 5' non-coding region will amplify the specific fragment 244bp from the cDNA. Finally, the PCR product will enter the sequencing process using the Trugene sequencer of Siemens.
Results:
Genotypes 1 and 6 were the commonest genotypes, followed by genotype 2 and genotype 3 was rarely found.
Genotype 1 was seen in 59.98% (Type 1: 9.39%; type 1a: 12.96%; type 1b: 37.63%) while genotype 6 in 24.15% (Type 6: 1.28%, type 6a: 22.68%, type 6b: 0.19%), genotype 2 in 15.82% (Type 2: 0.3%%; type 2a: 13.67%, type 2b: 0.52%, type 2c: 1.19%, type 2d: 0.14%) and genotype 3 was 0.05% ( Type 3a: 0.025%; type 3b: 0.025%).
Conclusions:
Our study indicated that HCV genotypes 1 and 6 are common in Vietnamese patients. Subtype 1b is the most common one. Only 0.05% of patients carried genotype 3.

Hepatology International, V 6,N1, 2012, Abstract pp12-027

16. Hội nghị gan mật toàn quốc tại Đà nẳng 17-18/08/2012

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17. Hội nghị gan mật TP. Hồ Chí Minh 25/11/2012

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18. Hội nghị: Chung tay vì một Việt nam không viêm gan.

TP. Hồ Chí Minh 13 - 03 - 2013
Hà nội 15 - 03 - 2013

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19. HỘI NGHỊ GAN MẬT CHÂU Á- THÁI BÌNH DƯƠNG - SINGAPORE 6/06 - 10/06/2013

POSTER 365

Impact of  Single Nucleotide Polymorphisms of IL28B on SVR in Treatment Chronic Hepatitis C Genotype 6 in Vietnamese Patients


Pham Thi Thu Thuy
Ho Tan Dat
Medic Medical Center - Ho Chi Minh City-Viet Nam


Aims:
-To determine the relationship between IL28B single nucleotide polymorphisms (SNPs) and sustained virologic response (SVR) rates to combination therapy of Peginterferon alfa and Ribavirin.
- Comparing SNPs allele frequencies in relation to other factors such as age, BMI, gender, AST/ALT ratio, viral load, EVR, RVR and fibroScan.
Method:
The study is designed as a retrospective review of the medical records of chronic HCV patients with genotype 6 . SNP of IL28B (rs12979860)  was identified by real-time polymerase chain reaction analysis of samples from 89 patients who were treated with Peginterferon alfa and Ribavirin . The duration of treatment was 48 weeks.
Results:
Patients with CC had higher rates of rapid virologic response (RVR) (84.44% vs. 50%, p=0.017) , but SVR rates were similar between those with CC and CT (88.31% vs. 75%, p=0.42). In the multivariable analysis (IL28B, age, BMI, gender, AST/ALT ratio, viral load, EVR, RVR and fibroScan), EVR and RVR predicted SVR, IL28B polymorphism did not affect the SVR. RVR remains the best predictor of SVR.
Conclusion:
An IL28B polymorphism was associated with an RVR in patients infected with genotype 6. But IL28B did not predict SVR . So determination of how IL28B will be used for treatment decisions in patients with genotype 6 remains to be further studied.

20. ỦY BAN KẾT NGHĨA VIỆT - MỸ TP. SAN FRANCISCO - TP HỒ CHÍ MINH - LỄ VINH DANH CÁC CÁ NHÂN ĐÃ CÓ NHỮNG ĐÓNG GÓP QUÝ BÁU TRONG CÁC LĨNH VỰC VĂN HÓA- KHOA HỌC VÀ Y TẾ - DINH THỐNG NHẤT NGÀY 6 THÁNG 7 NĂM 2013

21. HỘI NGHỊ GAN MẬT TOÀN QUỐC - HÀ NỘI  28-29/09/2013

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22. HỘI NGHỊ GAN MẬT HOA KỲ - WASHINGTON DC 01--05/11/2013

POSTER 1964
Impact of Single Nuleotide Polymorphisms of IL28B rs 12979860 on SVR in Treatment Chronic Hepatitis C Genotype 6 in Vietnamese Patients.

Pham Thi Thu Thuy, Ho Tan Dat
Medic Medical Center, HCM City

 

Abstract

Background:
Genetic variation in the interleukin 28B (IL28B) gene has been associated with the response to Peginterferon- alfa/ribavirin therapy in hepatitis C virus (HCV) genotype 1-infected patients. The importance of IL28B single nucleotide polymorphisms (rs12979860) for HCV genotype 6 infected patients is unknown.
Aims:
-To determine the relationship between IL28B single nucleotide polymorphisms (SNPs) and sustained virologic response (SVR) rates to combination therapy of Peginterferon alfa and Ribavirin.
- Comparing SNPs alle frequencies in relation to other factors such as age, BMI, gender, AST/ALT ratio, viral load, EVR, RVR and fibroScan.
Method:
The study is designed as a retrospective review of the medical records of chronic HCV patients with genotype 6. SNP of IL28B (rs12979860) was identified by real-time polymerase chain reaction analysis of samples from 102 patients who were treated with Peginterferon alfa and Ribavirin . The duration of treatment was 48 weeks.
Results:
Patients with CC had higher rates of rapid virologic response (RVR) (84.09% vs. 50%, p=0.010), but SVR rates were similar between those with CC and CT (87.5% vs. 71.4%, p=0.20). Patients with CT had higher rates of relapse (28.57% vs. 9%), but the difference was not statistical meaningful. In the multivariable analysis (IL28B, age, BMI, gender, AST/ALT ratio, viral load, EVR, RVR and fibroScan), only RVR predicted SVR, IL28B polymorphism did not affect the SVR. RVR remains the best predictor of SVR.
Conclusion:
An IL28B polymorphism was associated with an RVR in patients infected with genotype 6. But IL28B did not predict SVR. The relapse rate of patients with CT seemed to be higher than that of patients with CC. So determination of how IL28B will be used for treatment decisions in patients with genotype 6 remains to be further studied.

23. HỘI NGHỊ GAN MẬT CHÂU Á-THÁI BÌNH DƯƠNG

Brisbane -Australia- 12-15 March 2014

The different impacts of  IL28B genotype in Treatment Vietnamese Patients with chronic hepatitis C genotype 1 and 6

Pham Thi Thu Thuy
Ho Tan Dat
Medic Medical Center, HCM City

Abstract

Background:
A relationship between IL28B single nucleotide polymorphisms (SNPs) and sustained virologic response rates in combination therapy has been identified. However the impact of IL28B on SVR depends on HCV genotypes.
Aims:
We investigated the roles of polymorphism (rs 12979860) on the SVR to treatment of naive patients with HCV genotype 1 and 6.
-To determine the relationship between IL28B single nucleotide polymorphisms (SNPs) and sustained virologic response (SVR) rates to combination therapy of Peginterferon alfa and Ribavirin.
- Comparing SNPs allele frequencies in relation to other factors such as age, BMI, gender, AST/ALT ratio, viral load, EVR, RVR and fibroScan.
Method:
The study is designed as a retrospective review of the medical records of chronic HCV patients with genotype 1 and 6. SNP of IL28B (rs12979860) was identified by real-time polymerase chain reaction analysis of samples from 205 ( GT1=103, GT6= 102) patients who were treated with Peginterferon alfa and Ribavirin. The duration of treatment was 48 weeks.
Results:
Genotype 1 patients with CC had higher rates of rapid virologic response (RVR) (80% vs. 57.14%, p=0.036), and SVR rates were higher with CC (80% vs. 53.57%, p=0.015). Patients with CT had higher rates of relapse (33.33% vs. 16%, p=0.10), but the difference was not statistical meaningful. In the multivariable analysis (IL28B, age, BMI, gender, AST/ALT ratio, viral load, EVR, RVR and fibroScan), RVR, EVR and BMI  predicted SVR, IL28B polymorphism did not affect the SVR. RVR was the best predictor of SVR.
Genotype 6 patients with CC had higher rates of rapid virologic response (RVR) (84.09% vs. 50%, p=0.010), but SVR rates were similar between those with CC and CT (87.5% vs. 71.4%, p=0.20). Patients with CT had higher rates of relapse (28.57% vs. 9%, p=0.09), but the difference was not statistical meaningful. In the multivariable analysis (IL28B, age, BMI, gender, AST/ALT ratio, viral load, EVR, RVR and fibroScan), only RVR predicted SVR, IL28B polymorphism did not affect the SVR. RVR remains the best predictor of SVR.
Conclusion:
An IL28B polymorphism was associated with an RVR in patients infected with genotype 1 and 6. IL28B only predict SVR in genotype 1, not for genotype 6. The relapse rate of patients with CT seemed to be higher than that of patients with CC in both genotype 1 and 6. RVR was a strong predictor for SVR in both genotypes. Therefore IL28B should be used to predict SVR in genotype 1.

24. HỘI NGHỊ GAN MẬT THÀNH PHỐ HỒ CHÍ MINH

15/06/2014

Xem nội dung báo cáo (pdf file)

 

 

25. HỘI NGHỊ GAN MẬT TOÀN QUỐC

Nha Trang 26--27/07/2014

Xem nội dung báo cáo (pdf file)

26. HỘI NGHỊ GAN MẬT HOA KỲ- BOSTON- 7-11/11/2014

Poster 1462
THE DIFFERENT INCIDENCES OF HCV GENOTYPES USING TWO DIFFERENT REGIONS OF CLASSIFICATION: 5'NC AND NS5B IN VIETNAMESE PATIENTS AT MEDIC MEDICAL CENTER

Pham Thi Thu Thuy
Ho Tan Dat
Nguyen Bao Toan
Medic Medical Center- Ho Chi Minh City

ABSTRACT

Background:
HCV genotypes are clinically important for predicting the response to and determining the duration of therapy. Especially with the advent of new DAAs implying that these regimens depend on the HCV genotypes, determining genotypes is very important. Some studies indicated that using the 5'NC region to define HCV genotypes led to mis-classification of genotype 6 into genotype 1 than when using NS5B or core regions.
Aim:
- Identify HCV genotypes using 5'NC and NS5B regions.
- Identify HCV genotypes with using NS5B for the patients genotype 1 were identified by using 5'NC.
Methods:
This was a retro- sectional study. We studied 3 groups of patients: Group I included 3686 patients using 5'NC region (male 48.86%, female 51,14% with mean age of patients 49.20 ± 11.48 from January
2007 to August 2011); Group II included 176 patients using NS5B (male 43.19% , female 56.81% with mean age of patients 50.01 ± 8.63 from August 2013 to May 2014); Group III included 101  patients with genotype 1 using 5’NC who were randomly  genotyped again by using NS5B (male 41.58%, female  58.42%  with mean age of patients  53.12 ± 11.02 from August 2013  to April 2014).
We performed the sequencing of the hepatitis C virus genome: using 5’NC Trugene system of Siemens, using NS5B with system of ABI PRISM® 3730XL Analyzer, 96 capillary type (Applied Biosystems).

Results:
Group I: Genotype 1 was the most common 59.98% (genotype 1: 9.39%, 1a: 12.96%, 1b: 37.63%); genotype 6: 24.15% ( genotype 6: 1.28%, 6a: 22.68%, 6b: 0.19%), genotype 2: 15.82% ( genotype 2: 0.3%, 2a: 13.67%, 2b: 0.52%, 2c:1.19% and  2d: 0.14%), and genotype 3: 0.05% ( genotype 3a: 0.025% and  3b: 0.025%).
Group II: Genotype 6 was the most common: 46.59% (genotype 6: 1.14%, 6a: 19.31%, 6e: 23.86%, 6h: 1.14%, 6r: 1.14%); genotype 1: 42.05% (genotype 1a: 29.55%, 1b: 12.50%); genotype 2: 11.36% ( genotype 2a: 1.14%, 2m: 10.22%).
Group III: Genotype 1 was the most common: 78.21% (genotype 1a: 36.63%, 1b: 41.58 %); genotype 6: 19.80 % (genotype 6a: 0.99%, 6e: 14.85%, 6h: 1.98%, 6p:  0.99%, 6t: 0.99%); genotype 2: 1.98% (only genotype 2m).
Conclusion:
When using region NS5B to identify HCV genotypes, our study indicated that genotype 6 was the most common. The rate of mis-classification of genotype 6 into genotype 1 when using 5'NC was 19.80% an in this group genotype 6e had highest rate 75%.

 

 

27. Hội nghị khoa học chuyên đề nội khoa -12/07/2015 - Khách sạn Windsor Plaza

Xem nộ dung báo cáo Chẩn đoán sớm xơ gan (pdf)

28. Hội nghị Gan Mật toàn quốc - 25, 26/07/2015 - Hà Nội

Xem nội dung báo cáo Cơ hội và thách thức trong điều trị viêm gan C tại Việt Nam (pdf)

 

29. Lớp tập huấn: "Nâng cao năng lực cho cán bộ y tế về chẩn đoán và điều trị viêm gan virus C'

(Tháng 10-11/2015- TP Hồ Chí Minh, Cần thơ , Kiên Giang, Đà Nẵng)

 

30. BƯỚC ĐỘT PHÁ TRONG ĐIỀU TRỊ VIÊM GAN C 2016

KHÁCH SẠN REX -24/04/2016

Xem nội dung báo cáo Hiệu quả của phác đồ SOFOSBUVIR kết hợp RIBAVIRIN ± PegIFN ở bệnh nhân viêm gan mạn tính GEN 1& 6
(pdf)

31. XU HƯỚNG MỚI TRONG NÂNG CAO HIỆU QUẢ QUẢN LÝ BỆNH TRUYỀN NHIỄM

Trung Tâm Hội nghị GEM - TP HCM - 19/06/2016

Xem nội dung báo cáo VAI TRÒ ĐỊNH LƯỢNG CÁC KHÁNG NGUYÊN HBV TRONG THỰC HÀNH LÂM SÀNG

32.CHẨN ĐOÁN VÀ ĐIỀU TRỊ VIÊM GAN B & C- THÁCH THỨC VÀ GIẢI PHÁP

THÀNH PHỐ HUẾ
16/07/2016

Xem nội dung báo cáo CẬP NHẬT ĐiỀU TRỊ VIÊM GAN B MẠN TÍNH (pdf file).

33. HỘI THẢO QUỐC TẾ: CÙNG HÀNH ĐỘNG VÌ MỤC TIÊU LOẠI TRỪ VIÊM GAN SIÊU VI B&C

30-31/07/2016
TRUNG TÂM HỘI NGHỊ TP HCM

Xem nội dung báo cáo THỬ THÁCH VÀ CƠ HỘI TRONG KIỂM SOÁT VIÊM GAN SIÊU VI B, C và UNG THƯ GAN TẠI TP. HỒ CHÍ MINH (pdf file).

 

34. VIÊM GAN SIÊU VI B&C- NHỮNG VẤN ĐỀ CẦN QUAN TÂM

KHÁCH SẠN LEGEND- TP HCM
28/08/2016

Xem nội dung báo cáo THỬ THÁCH TRONG ĐIỀU TRỊ VIÊM GAN SIÊU VI B & C TẠI VIỆT NAM – HƯỚNG GIẢI QUYẾT (file pdf)

35.HỘI NGHỊ KHOA HỌC TOÀN QUỐC VỀ BỆNH TRUYỀN NHIỄM VÀ HIV/AIDS

Bệnh Viện Nhiệt Đới Trung Ương
17 - 18/08/2016

Xem nội dung báo cáo TỐI ƯU HÓA ĐIỀU TRỊ VIÊM GAN C MẠN TÍNH VỚI CÁC THUỐC DAAs (file pdf)

36. HỘI NGHỊ GAN MẬT HOA KỲ- BOSTON 11/11 - 15/11/2016

Poster 1929
THE EFFICACY AND SAFETY OF SOFOSBUVIR PLUS RIBAVIRIN WITH OR WITHOUT PEG-INTERFERON IN TREATMENT OF NAÏVE AND EXPERIENCED VIETNAMESE PATIENTS WITH CHRONIC GENOTYPE 1 AND 6 HCV INFECTION.
Pham Thi Thu Thu,MD,PhD
Ho Tan Dat MD
Medic Medical Center

SUMMARY:

Background.
The recent development of direct acting antivirus (DAA) has changed the field of hepatitis C. Many new DAAs drugs can cure more than 90% of chronic hepatitis C virus cases worldwide but in Viet Nam there is only Sofosbuvir from India. So we study the efficacy and safety of sofosbuvir plus ribavirin with or without peg-interferon in treatment of naïve and experienced Vietnamese patients with chronic genotype 1 and 6 HCV infection.
Aims.
- To evaluate the antiviral efficacy of sofosbuvir (SOF) + ribavirin (RBV) ± peg-interferon (PegIFN) by the proportion of subjects with sustained virologic response (SVR) 24 weeks after discontinuation of therapy.
- To evaluate the safety and tolerating of SOF+ RBV ± PegIFN.
- To consider which factors contribute to predicting the SVR.

Patients and methods.
We conducted an open-labeled randomized prospective trial of naïve and experienced patients with HCV genotype 1 and 6 at Medic Medical Center in Ho Chi Minh City. 120 chronic hepatitis C patients with genotype 1 and 6 were classified into 4 groups:
-Group IA included 40 patients with genotype 1 who received 12 weeks of treatment with SOF+ RBV+ PegIFN
- Group IB included 20 patients with genotype 1 who received 24 weeks of treatment with SOF+ RBV
- Group IIA included 40 patients with genotype 6 who received 12 weeks of treatment with SOF+ RBV+ PegIFN
- Group IIB included 20 patients with genotype 6 who received 24 weeks of treatment with SOF+ RBV.
SVR was defined as undetectable HCV RNA after 24 weeks of follow-up. Ages, genders, BMI, IL28B, FibroScan, naïve and experienced of patients were the factors for evaluating the effectiness of the treatment and the prognosis.
Results.
SVR of group IA was 100%, IB was 90%, IIA was 100%, IIB was 100%. (p>0.05)
Two patients of group IB relapsed: one  naïve , genotype 1b, FibroScan F4 and another  experienced, genotype 1b, FibroScan F4.
The adverse events were rare in groups with SOF and RBV treatment. Some adverse events in groups with SOF+RBV +PegIFN were slight and did not necessitate medication or reduced dosage of  RBV.

Conclusion.
Regimes of therapy SOF plus RBV with or without PegIFN were effective and safe for Vietnamese patients with chronic hepatitis C genotype 1 and 6. SVR in genotype 6 was better than that of genotype 1. SVR was the same between naïve and experienced subjects. IL28B factor did not impact SVR.

37. Hội thảo vệ tinh: KỶ NGUYÊN MỚI TRONG QUẢN LÝ BỆNH VIÊM GAN VIRUS C MẠN

KHÁCH SẠN NEW WORLD - TP. Hồ Chí Minh - 17/12/2016

Xem nội dung báo cáo HIỆN TRẠNG VÀ THÁCH THỨC TRONG CHẨN ĐOÁN & ĐIỀU TRỊ HCV MẠN TÍNH TẠI VIỆT NAM

38. HỘI NGHỊ GAN MẬT CHÂU Á- THÁI BÌNH DƯƠNG

Thượng Hải- Trung Quốc, 15 - 18/2/2017

1. Poster PP 0214
Impact Of a 12-Week Oral Regimen of Elbasvir/Grazoprevir (EBR/GZR) On Health-related Quality of Life (HRQOL) and Fatigue In Treatment-Naïve Patients With Chronic Hepatitis  C Virus (HCV) Genotype (GT) 1, 4, or 6 Infection: Data from the C-CORAL Study

Nội dung poster(pdf file)

2.Presentation
Sofosbuvir + Ribavirin for 24 weeks or Sofosbuvir + Pegylated-interferon + Ribavirin for 12 Weeks in Genotype 1 or Genotype 6 HCV-infected Patients: Results from a Phase 3 Study in Vietnam

Nội dung(pdf file)

39. HỘI THẢO QUỐC TẾ: CÙNG HÀNH ĐỘNG VÌ MỤC TIÊU LOẠI TRỪ VIÊM GAN B& C TẠI VIỆT NAM

Trung Tâm hội nghị TP HCM - 29-30/07/2017

Viêm gan C và rượu (Nội dung tham luận - pdf file)

40. HỘI NGHỊ TRUYỀN NHIỄM TOÀN QUỐC

Ninh Bình 08 - 09/09/2017

TAF - Lựa chọn mới -Hiệu quả -An toàn trên thận & xương cho bệnh nhân viêm gan siêu vi B mạn.

TS.BS.Phạm Thị Thu Thủy
Trung Tâm Y Khoa Medic-TP HCM

Theo WHO năm 2017 ước tính 257 triệu ngưới đang sống với bệnh viêm gan do HBV. Trong đó tỷ lệ hiện mắc viêm gan do HBV trên người trưởng thành mắc bệnh ở Tây Thái Bình Dương là cao nhất 6,2%, theo sau đó là tỉ lệ xơ gan và ung thư gan ngày càng tăng.
Vấn đề điều trị còn nhiều khó khăn và phức tạp. Thuốc tiêm Peg IFN thì đắt tiền và nhiều tác dụng phụ, các loại thuốc uống thì uống rất lâu dài, gần như không hạn định thời gian...Tenofovir disoproxil fumarate (TDF) được đánh giá là có hiệu quả cao, tuy nhiên ảnh hưởng nhiều đến xương và thận. Tenofovir Alafenamide (TAF) là loại Tenofovir mới với các ưu điểm: sự ổn định trong huyết tương tốt hơn TDF, tăng phân phối thuốc hoạt động đến tế bào gan,  giảm lượng TFV trong tuần hoàn do đó có thể giảm liều TAF còn 25mg. Dùng không ảnh hưởng xương và an toàn cho thận.
Nghiên cứu của Maria và cs (Lancet 2016) trên 426 bệnh nhân HbeAg âm tính cho thấy TAF hiệu quả như TDF nhưng an toàn cho xương và thận. Nghiên cứu của Henry Chan và cs  (Lancet 2016) trên 1473 bệnh nhân HBeAg (+) cũng cho kết quả tương tự. Nghiên cứu của M. Brunetto và cs (EASL 2017)  trên 425 bệnh nhân HBeAg âm tính được điều trị ngẫu nhiên TAF 25mg hay TDF 300mg, ở tuần 96 , đáp ứng virus của TAF là 90% và của TDF là 91%. Tỉ lệ bình thường men ALT của nhóm TAF cao hơn TDF (81% vs. 71%, p=0,038)
TAF hiện nay là thuốc uống được chọn lựa đầu tay cho điều trị viêm gan B vì khả năng ức chế virus cao , không kháng thuốc, an toàn cho xương và thận, đặc biệt dùng an toàn cho người lớn tuổi , người có tiền sử bệnh xương và người có chức năng thận yếu.

TAF- New – Effective - Safe Option for kidney & bone in patients with chronic hepatitis B.

Pham Thi Thu Thuy, M.D., Ph.D.
Medic Medical Center - HCMC

According to WHO’s estimation, the number of people with hepatitis caused by HBV is about 257 million in 2017. Among these, adults ratio with hepatitis caused by HBV in the Western Pacific is 6.2%, which is the highest percentage, and is followed by an increasing ratio of cirrhosis and liver cancer.  
Treatments have faced numerous difficulties and complexities. Peg IFN injections are expensive and have many side effects; some other oral medicines require a long treatment time, and some with uncertain duration. Tenofovir disoproxil fumarate (TDF) is considered to be highly effective. However it has damaging side effects on the bones and kidneys. Tenofovir Alafenamide (TAF) is a new type of Tenofovir with advantages such as greater plasma stability in comparison with TDF, enhancement delivery of active drug to hepatocytes, and TFV reduction in the circulation which can lead to the reduction of TAF to 25 mg. Using this has no side effects on bones and is safe for kidneys.
A study by Maria et al. (Lancet 2016) on 426 HBeAg-negative patients showed that TAF was as effective as TDF and is safe for bones and kidneys. The study by Henry Chan et al. (Lancet 2016) on 1473 patients with HBeAg- positive  also showed similar results. In the study of  M.Brunetto et al . (EASL 2017) ,  425 patients with HBeAg- negative were randomized to receive TAF 25mg or TDF 300 mg. At week 96 , virologic response rates were 90% and 91% in the TAF and TDF groups respectively. A greater percentage of TAF patients achieved normalization of serum ALT values (81% vs. 71%, p=0,038).

TAF is currently the first choice of oral drug for the treatment of hepatitis B because of its high rates of virological  suppression, no evidence of virological resistance, better renal and bone safety profile than TDF. Especially for older people and people with a history of  bone diseases and weak renal function.

41. HỘI NGHỊ GAN MẬT TOÀN QUỐC

HUẾ 4 - 5/11/2017

VIÊM GAN SIÊU VI C VÀ RƯỢU BIA
TRƯỜNG HỢP LÂM SÀNG
TS.BS. Phạm Thị Thu Thủy
BS. Hồ Tấn Đạt
Trung Tâm Y Khoa Medic- TP HCM

Nội dung tham luận (file pdf)




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