{"id":2034,"date":"2016-10-01T01:00:00","date_gmt":"2016-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/et-si-on-recontactait-les-patients-identifies-un-jour-vhc-experience-du-centre-hospitalier-annecy-genevois\/"},"modified":"2018-10-20T18:40:19","modified_gmt":"2018-10-20T16:40:19","slug":"et-si-on-recontactait-les-patients-identifies-un-jour-vhc-experience-du-centre-hospitalier-annecy-genevois","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/et-si-on-recontactait-les-patients-identifies-un-jour-vhc-experience-du-centre-hospitalier-annecy-genevois\/","title":{"rendered":"Et si on recontactait les patients identifi\u00e9s un jour VHC + ? Exp\u00e9rience du Centre Hospitalier Annecy Genevois."},"content":{"rendered":"

2016<\/strong><\/p>\n

HELUWAERT F, MONTCHAUD A, OLIVARI M, PEYRET CD, MAILLARD E, POFELSKI J, CAPONY P, GAILLAT J, JANSEN C, PIET E, TOLSMA V, VITRAT V, CHANZY B, JUND J, VALRAN A, BRU JP. Centre Hospitalier Annecy Genevois (74)<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02016-05-19 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Depuis l\u2019arriv\u00e9e du sofosbuvir, une v\u00e9ritable r\u00e9volution th\u00e9rapeutique est disponible pour les patients VHC +. Il devient d\u00e9sormais r\u00e9aliste \u00e0 moyen terme d\u2019\u00e9radiquer cette infection virale.
\nSi l\u2019identification des patients VHC + ne connaissant pas leur statut viral est un objectif de sant\u00e9 publique, cette identification bien qu\u2019encourag\u00e9e par les h\u00e9patogastro-ent\u00e9rologues sera probablement propos\u00e9e par les m\u00e9decins g\u00e9n\u00e9ralistes. Par contre, il nous a sembl\u00e9 important de nous concentrer sur les patients d\u00e9j\u00e0 identifi\u00e9s un jour VHC+ au sein de notre \u00e9tablissement, car si la plupart b\u00e9n\u00e9ficie d\u2019un suivi r\u00e9gulier, nombreux sont ceux qui ont \u00e9t\u00e9 perdu de vue en raison, entre autres d\u2019une intol\u00e9rance ou d\u2019une non \u00e9ligibilit\u00e9 \u00e0 l\u2019interf\u00e9ron, ou d\u2019une fibrose qualifi\u00e9e jusqu\u2019ici comme minime.
\nLe but de notre travail a \u00e9t\u00e9 d\u2019exploiter dans un premier temps une cohorte personnelle de patients VHC +, puis de demander au syst\u00e8me informatique de l\u2019\u00e9tablissement de ressortir tous les patients \u00e9tiquet\u00e9s VHC + depuis 8 ans sur les donn\u00e9es PMSI (date du nouveau syst\u00e8me d\u2019exploitation) ainsi que tous les patients avec vir\u00e9mie positive diagnostiqu\u00e9s sur le laboratoire hospitalier.
\nCes recherches ont permis d\u2019identifier 640 patients VHC + sur les donn\u00e9es PMSI, 250 sur les donn\u00e9es du laboratoire et 130 au sein d\u2019une cohorte personnelle. (pr\u00e9sence de doublons)
\nLa premi\u00e8re \u00e9tape \u00e9tait de re-screener l\u2019ensemble des patients de ma cohorte personnelle (n=130). Tous ont donc \u00e9t\u00e9 recontact\u00e9s si besoin, par courrier, avec proposition de r\u00e9aliser un test non invasif de fibrose, pr\u00e9alablement \u00e0 une consultation.
\nUn an apr\u00e8s le d\u00e9but de ce travail, les r\u00e9sultats sont les suivants :
\nPatients suivis en CHU (n=5), suivis dans autre \u00e9tablissement(n=3), perdus de vue (n=5), d\u00e9c\u00e9d\u00e9s (n=18), suivi interrompu (d\u00e9mence \u2013 cancer \u00e9volutif : n=5), patients gu\u00e9ris (n=43), en attente de RVS 12 (n=5), non r\u00e9pondeur NAAD (n=1), en cours de traitement (n=10), en attente de traitement (RCP valid\u00e9e)(n=2), bilan en cours (n=9), non \u00e9ligible (n=25)
\nEn enlevant de la cohorte les d\u00e9c\u00e9d\u00e9s, les arr\u00eats de suivi et les perdus de vue d\u00e9finitif, il reste 98 patients en cours de suivi dans la cohorte : 42 d\u2019entre eux ont \u00e9t\u00e9 relanc\u00e9s par courrier en 2015, seuls 5 n\u2019ont pas r\u00e9pondus au courrier \u00e0 ce jour. Sur les 37 r\u00e9pondants \u00e0 la relance, 14 patients ont gu\u00e9ris suite \u00e0 la prescription d\u2019un NAAD, 3 sont en attente de RVS, 7 en cours de traitements, 1 dossier valid\u00e9 en RCP, 1 non r\u00e9pondeur aux NAAD et 11 non \u00e9ligibles. Plus de 50 % des relanc\u00e9s seront donc prochainement consid\u00e9r\u00e9s comme \u00ab gu\u00e9ris \u00bb
\nCe syst\u00e8me de relance a permis de proposer de nombreux traitements au patient de ma cohorte, la plupart ayant \u00e9t\u00e9 contre indiqu\u00e9s pr\u00e9alablement a l\u2019interf\u00e9ron et pr\u00e9sentant des l\u00e9sions h\u00e9patiques \u00e9volu\u00e9es (F3 minimum). Les patients ont \u00e9t\u00e9 extr\u00eamement touch\u00e9s et reconnaissants de cette d\u00e9marche.
\nA ce jour, sur les 98 patients, seuls 11 n\u2019ont pas eu d\u2019\u00e9valuation de la fibrose depuis moins de 2 ans (la plupart \u00e9tant en cours de bilan). Cette parfaite identification des patients, la connaissance de leur degr\u00e9 de fibrose nous permettent de leur proposer un traitement adapt\u00e9 d\u00e8s l\u2019\u00e9largissement des indications.
\nCes excellents r\u00e9sultats nous ont conduits \u00e0 proposer cette d\u00e9marche \u00e0 tous les patients identifi\u00e9s dans la cohorte d\u2019ici juin 2016, ce travail \u00e9tant r\u00e9alis\u00e9 en collaboration avec les infectiologues gr\u00e2ce \u00e0 une attach\u00e9e de recherche clinique. A ce jour, cette cohorte identifie 500 patients VHC +, avec moins de 10 % de perdus de vus. Les r\u00e9sultats d\u00e9finitifs actualis\u00e9s seront pr\u00e9sent\u00e9s au congr\u00e8s.<\/p>\n

Cette d\u00e9marche simple et efficace m\u00e9riterai d\u2019\u00eatre connue pour proposer au plus grand nombre des patients identifi\u00e9s un jour VHC +, un traitement souvent synonyme de gu\u00e9rison.<\/p>\n","protected":false},"excerpt":{"rendered":"

2016 HELUWAERT F, MONTCHAUD A, OLIVARI M, PEYRET CD, MAILLARD E, POFELSKI J, CAPONY P, GAILLAT J, JANSEN C, PIET E, TOLSMA V, VITRAT V, CHANZY B, JUND J, VALRAN A, BRU JP. Centre Hospitalier Annecy Genevois (74) H\u00e9patologie – \u00a02016-05-19 –\u00a0CO – ________________________________ Depuis l\u2019arriv\u00e9e du sofosbuvir, une v\u00e9ritable r\u00e9volution th\u00e9rapeutique est disponible pour […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[27],"class_list":["post-2034","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-27"],"yoast_head":"\nEt si on recontactait les patients identifi\u00e9s un jour VHC + ? 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