ผู ป วยไวรัสตับอักเสบ ซี ... C Guideline 2016.pdfปฏ บ ต ทางสมาคมฯ หว งว าแนวทางการร

.. 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

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02-879-9154-602-879-9153

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www.parbpim.com

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

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..2559

..2559

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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