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Text of ผู ป วยไวรัสตับอักเสบ ซี ... C Guideline 2016.pdfปฏ...

  • .. 2559

    Thailand Practice Guideline for Managementof Chronic Hepatitis C 2016

  • .. 2559

    Thailand Practice Guideline for Managementof Chronic Hepatitis C 2016

  • 1 2559 3,0002558

    ISBN978-616-279-833-7978-616-279-685-2

    1575/14

    .

    10400

    45/12-14,334-

    11130

    02-879-9154-602-879-9153

    [email protected]

    www.parbpim.com

    .. 2559Thailand Practice Guideline for Management of Chronic Hepatitis C 2016

  • .. 2558

    ..2559

    ..2559

  • .. 2558-2559

    1

  • .. 2559

    Thailand Practice Guideline for Management of Chronic

    Hepatitis C 2016

    anti-HCV

    HCV RNA

    HCVRNA15IU/mL

    HCV RNA HCV RNA 3-6

    HCV RNA (false positive)

    HCVRNA

    - (Liver Function Test;

    LFT),completebloodcountcoagulogram

    - HBsAg,anti-HBc,anti-HIVanti-HAVantibodies

    -

    -

    - (HCVgenotype)

    HCVRNAanti-HCV

    (acutehepatitisC)

    HIV

  • Chronic Hepatitis C 2016 7

    significant fibrosis

    -

    METAVIR2

    - transientelastography

    7.0kilopascal(kPa)

    - (acoustic

    radiationforceimpulseimaging)1.2

    - a-2-macroglobulin, gamma-glutamyl

    transpeptidase,apolipoproteinA1,haptoglobintotalbilirubin

    Fibrotest0.48

    - platelets,a-2-macroglobulin, alanine

    aminotransferase, aspartateaminotransferase, gamma-glutamyl

    transpeptidase,urea,prothrombinindex

    Fibrometer0.64

    -

    -

    METAVIR4

    - transientelastography

    13kPa

    - (acoustic

    radiationforceimpulseimaging)1.8

    - a-2-macroglobulin, gamma-glutamyl

    transpeptidase,apolipoproteinA1,haptoglobintotalbilirubin

  • Chronic Hepatitis C 2016 8

    Fibrotest0.74

    - platelets, a-2-macroglobulin, alanine

    aminotransferase, aspartateaminotransferase, gamma-glutamyl

    transpeptidase,urea,prothrombinindex

    Fibrometer0.78

    (decompensated

    cirrhosis)

    (bridgingfibrosis)METAVIR

    3

    HIV

    HBV

    HCV

  • Chronic Hepatitis C 2016 9

    (significantfibrosis)

    METAVIR2

    HCV

    -

    -

    METAVIR

    01

    - Pegylatedinterferonalfa2a2b

    - Ribavirin

    - Boceprevir

    - Sofosbuvir

    - Daclatasvir

    - simeprevir sofosbuvir

    ledipasvirparitaprevir/ritonavirombitasvir

    dasabuvir

  • pegylated interferon ribavirin

    1

    1: pegylated interferon 1

    ribavirin 2 sofosbuvir

    400112

    2: sofosbuvir 400 1

    daclatasvir601

    12

    3: sofosbuvir400ledipasvir

    90112

    81bHCVRNA

    6,000,000IU/mL

    4: sofosbuvir 400 1

    simeprevir1501

    12

    :simeprevir1aQ80kvariant

    5: paritaprevir 150

    ritonavir 100 ombitasvir 25

    1dasabuvir2502

    12

    : ribavirin 2

    1a

  • Chronic Hepatitis C 2016 11

    1: pegylated interferon 1

    ribavirin 2 sofosbuvir

    400112

    2: sofosbuvir 400 1

    daclatasvir 60 1

    ribavirin 2 12

    ribavirin 24

    3: sofosbuvir 400 1

    ledipasvir 90 1

    ribavirin 2 12

    ribavirin24

    4: sofosbuvir 400 1

    simeprevir 150 1

    ribavirin 2 12

    ribavirin 24

    5: paritaprevir150ritonavir

    100ombitasvir25

    1dasabuvir2502

    ribavirin212

    1b241a

    2

    1: pegylated interferon 1

    ribavir in 2 sofosbuvir

    400 1 12

  • Chronic Hepatitis C 2016 12

    2: sofosbuvir 400 1

    daclatasvir601

    12

    3: sofosbuvir 400

    ribavirin 2 12

    16 24

    3

    1: pegylated interferon 1

    ribavirin 2 sofosbuvir

    400112

    2: sofosbuvir 400 1

    ribavirin 2 24

    3: sofosbuvir4001

    daclatasvir6012

    1: pegylated interferon 1

    ribavirin 2 sofosbuvir

    400112

    2: sofosbuvir 400 1

    daclatasvir 60 1

    ribavirin1,000-1,200

    21624

    : 12 bridging

    fibrosis

  • Chronic Hepatitis C 2016 13

    4

    1: pegylated interferon 1

    ribavirin 2 sofosbuvir

    400112

    2: sofosbuvir 400 1

    daclatasvir601

    12

    3: sofosbuvir 400 1

    ledipasvir901

    12

    4: sofosbuvir 400 1

    simeprevir1501

    12

    1: pegylated interferon 1

    ribavirin 2 sofosbuvir

    400112

    2: sofosbuvir 400 1

    daclatasvir 60 1

    ribavirin 2 12

    ribavirin 24

    3: sofosbuvir 400 1

    ledipasvir 90 1

    ribavirin 2 12

    ribavirin 24

  • Chronic Hepatitis C 2016 14

    4: sofosbuvir 400 1

    simeprevir 150 1

    ribavirin 2 12

    ribavirin 24

    5

    6

    1: pegylated interferon 1

    ribavirin 2 sofosbuvir

    400112

    2: sofosbuvir 400 1

    daclatasvir 601

    12

    3: sofosbuvir 400 1

    ledipasvir901

    12

    1: pegylated interferon 1

    ribavirin 2 sofosbuvir

    400112

    2: sofosbuvir 400 1

    daclatasvir 60 1

    ribavirin 2 12

    ribavirin 24

    3: sofosbuvir 400 1

    ledipasvir 90 1

    ribavirin212

    ribavirin24

  • Chronic Hepatitis C 2016 15

    SOF/Peg/RBV

    SOF/RBV SOF/LDV AbbVies SOF/SMP SOF/DCV

    G1a 12 8-12

    12+RBV

    12 12

    G1b 12

    G2 12 12 12

    G3 12 24 12

    G4 12 12 12 12

    G5/6 12 12 12

    .G,genotype;DCV,daclatasvir;LDV,ledipasvir;Peg,pegylatedinterferon;SOF,sofosbuvir;SMP,simeprevir;RBV,ribavirin.AbbViesparitaprevir,ritonavir,ombitasvirdasabuvir

  • Chronic Hepatitis C 2016 16

    SOF/Peg/RBV

    SOF/RBV

    SOF/LDV AbbVies SOF/SMP SOF/DCV

    G1a 12

    24

    12+

    RBV

    24+

    RBV

    24

    12+

    RBV

    24

    12+RBV

    G1b 12+

    RBV

    G2 12

    16-20

    12

    G3 12

    16-24+

    RBV

    G4 12

    24

    12+

    RBV

    24

    12+

    RBV

    24

    12+RBV

    G5/6 12

    24

    12+

    RBV

    24

    12+RBV

    .G,genotype;DCV,daclatasvir;LDV,ledipasvir;Peg,pegylatedinterferon;SOF,sofosbuvir;SMP,simeprevir;RBV,ribavirin.AbbViesparitaprevir,ritonavir,ombitasvirdasabuvir

  • Chronic Hepatitis C 2016 17

    :pegylatedinterferon/ribavirin

    pegylated interferon alfa-2a

    1801

    ribavirin

    - 1,00075

    - 1,20075

    pegylated interferon alfa-2b

    1 1.5 1 1

    ribavirin

    - 80065

    - 1,0006585

    - 1,20085105

    - 1,400105

    ribavirin pegylated interferon

    ribavirin pegylated interferon

    alfa-2a

    interferon ribavirin

    - (decompensatedcirrhosis)

    - interferon/ribavirin

    -

    -

    -

    - interferon

    -

  • Chronic Hepatitis C 2016 18

    1

    boceprevir

    1: sofosbuvir 400 1

    daclatasvir 60 1

    ribavirin 2 12

    24 (bridging fibrosis)

    2: sofosbuvir 400 1

    ledipasvir 90 1

    ribavirin 2 12

    24 (bridging fibrosis)

    3: sofosbuvir 400 1

    simeprevir 150 1

    ribavirin 2 12

    24 (bridging fibrosis)

    4: paritaprevir 150

    ritonavir 100 ombitasvir 25

    1 dasabuvir 250 2

    ribavirin 2 12

    24 (bridging fibrosis)

  • Chronic Hepatitis C 2016 19

    (decompensated cirrhosis)

    - Child-Pughscore13

    15

    - Child-Pughscore12

    1, 4 6

    1: sofosbuvir 400 1

    daclatasvir 60 1

    ribavirin 2 12

    ribavirin 24

    ribavirin600200

    2: sofosbuvir 400 1

    ledipasvir 90 1

    ribavirin 2 12

    ribavirin 24

    ribavirin600200

    3: sofosbuvir 400 1

    simeprevir 150 1

    daclatasvir601 12

  • Chronic Hepatitis C 2016 20

    2 3

    1: sofosbuvir 400 1

    ribavirin 2 24

    2: sofosbuvir 400 1

    daclatasvir 60 1

    ribavirin 2 12

    ribavirin 24

    HIV

    -

    HIV

    -

    HIVwww.hep-druginteractions.

    org/HEPDrugInteractions

    -

    - HBV DNA

    HBVDNA2000IU/mL

    - (GlomerularFiltrationRate;GFR

    30 /)

  • Chronic Hepatitis C 2016 21

    - (GFR 30 /)

    simeprevir,

    daclatasvir,paritaprevirritonavirparitaprevir

    ombitasvirdasabuvir

    sofosbuvirGFR30/

    2, 3, 5 6

    -

    -

    (compensated cirrhosis) pegylated

    interferonalfa-2a135

    1 pegylated interferon alfa-2b

    1 1 1 24

    2348

    56

    - ribavirin

    1 4

    - Daclatasvir601asunaprevir

    200212

    :1b

    80,000/.

    -

    paritaprevir150ritonavir

    100ombitasvir25

  • Chronic Hepatitis C 2016 22

    1dasabuvir2502

    ribavirin2

    12

    - (compensated cirrhosis)

    pegylated interferon alfa-2a

    135 1 pegylated interferon

    alfa-2b 1 1

    148ribavirin

    -

    (decompensatedcirrhosis)

    - sofosbuvir4001

    ribavirin2

    -

    3-6

  • Chronic Hepatitis C 2016 23

    12

    1, 4 6

    1: sofosbuvir 400 1

    daclatasvir601ribavirin

    212

    ribavirin 24

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