Publication: Fiabilidad de la elastografía de transición para predecir eventos hepáticos y supervivencia en pacientes coinfectados por VIH y VHC
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2017-08-29
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Universidad Complutense de Madrid
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Abstract
La coinfección por el VHC ha sido la principal comorbilidad de los pacientes infectados por el VIH debido a que ambos virus comparten mecanismos de transmisión [1]. En el paciente infectado por VIH, la coinfección por el VHC es un problema de gran magnitud no solo por su frecuencia, sino porque la progresión de la fibrosis hepática es más rápida que entre la población no infectada por VIH. Todo ello ha contribuido a que las complicaciones asociadas con la enfermedad hepática terminal por VHC hayan sido una de las principales causas de morbimortalidad en pacientes coinfectados por VIH después de la introducción de la terapia antirretroviral de gran eficacia [2]. Uno de los aspectos más importantes en la asistencia de los pacientes con hepatitis C es la estadificación de la fibrosis hepática, pues resulta imprescindible para la toma de decisiones terapéuticas y para establecer el pronóstico de los pacientes [3]. Tradicionalmente esto se ha llevado a cabo mediante biopsia hepática [4, 5]. Sin embargo, este es un procedimiento cruento y no tan fiable como normalmente se asume dado que no siempre se obtiene una muestra lo suficientemente grande y que la fibrosis hepática no tiene una distribución homogénea, de lo que se derivan problemas de muestreo [6]. Uno de los principales cambios en la práctica de la hepatología de la última década ha sido el abandono por parte de los clínicos de la biopsia como procedimiento de elección para la estadificación de la fibrosis hepática en pacientes con hepatitis C, y la adopción casi mayoritaria de métodos no invasivos para este cometido, entre los cuales destaca la elastografía de transición [7]...
HCV coinfection has been the major comorbidity of patients infected by HIV because both viruses share transmission mechanisms [1]. In HIV-infected patients, HCV coinfection is a major problem not only because of their frequency, but because the progression of liver fibrosis is faster than among HIV-uninfected population. All this has contributed to the emergence of end-stage liver disease due to HCV as a major cause of morbidity and mortality in patients coinfected with HIV after the introduction of effective antiretroviral therapy [2 70]. One of the most important aspects in the care of patients with hepatitis C is the staging of liver fibrosis, since it is essential for making treatment decisions and to establish the prognosis of patients [3]. Traditionally, this has been done by liver biopsy [4 2429, 5 2427]. However, this is an invasive procedure and not as reliable as normally assumed since due to sampling errors and non-homogeneous distribution of fibrosis [6 2430]. One of the major changes in the practice of hepatology in the last decade has been the abandonment of liver biopsy as a method of choice for staging of liver fibrosis in patients with hepatitis C, and the widespread adoption of noninvasive methods including transient elastography [7 201]...
HCV coinfection has been the major comorbidity of patients infected by HIV because both viruses share transmission mechanisms [1]. In HIV-infected patients, HCV coinfection is a major problem not only because of their frequency, but because the progression of liver fibrosis is faster than among HIV-uninfected population. All this has contributed to the emergence of end-stage liver disease due to HCV as a major cause of morbidity and mortality in patients coinfected with HIV after the introduction of effective antiretroviral therapy [2 70]. One of the most important aspects in the care of patients with hepatitis C is the staging of liver fibrosis, since it is essential for making treatment decisions and to establish the prognosis of patients [3]. Traditionally, this has been done by liver biopsy [4 2429, 5 2427]. However, this is an invasive procedure and not as reliable as normally assumed since due to sampling errors and non-homogeneous distribution of fibrosis [6 2430]. One of the major changes in the practice of hepatology in the last decade has been the abandonment of liver biopsy as a method of choice for staging of liver fibrosis in patients with hepatitis C, and the widespread adoption of noninvasive methods including transient elastography [7 201]...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 03-02-2016