{"id":2079,"date":"2017-10-01T01:00:00","date_gmt":"2017-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/hepatite-c-traitee-bonne-ou-mauvaise-reponse-un-cas-clinique-deroutant\/"},"modified":"2018-10-20T18:40:25","modified_gmt":"2018-10-20T16:40:25","slug":"hepatite-c-traitee-bonne-ou-mauvaise-reponse-un-cas-clinique-deroutant","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/hepatite-c-traitee-bonne-ou-mauvaise-reponse-un-cas-clinique-deroutant\/","title":{"rendered":"H\u00e9patite C  trait\u00e9e : bonne ou mauvaise r\u00e9ponse ? Un cas clinique d\u00e9routant !"},"content":{"rendered":"<p><strong>2017<\/strong><\/p>\n<p><em>ORTIZ Maria Del Carmen, REMY Andr\u00e9-Jean, HERVET J\u00e9r\u00e9my, BOUVHKIRA Hakim, MONTABONE Hakim, POURRET Anne<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02017-05-11 &#8211;\u00a0CC &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Les facteurs de mauvaise r\u00e9ponse au traitement de l\u2019h\u00e9patite C sont connus et peuvent expliquer les \u00e9checs des nouveaux traitements antiviraux directs, m\u00eame avec des taux de r\u00e9ponses sup\u00e9rieurs \u00e0 95%. Mr A pr\u00e9sente une h\u00e9patite C de g\u00e9notype 4 connue depuis 2005, li\u00e9e \u00e0 une contamination intraveineuse en 1983. Le bilan initial mettait en \u00e9vidence une fibrose au stade F3. Mr A a \u00e9t\u00e9 trait\u00e9 3 fois sans succ\u00e8s entre 2007 et 2011 : \u00e0 2 reprises par interf\u00e9ron p\u00e9gyl\u00e9 et ribavirine (r\u00e9pondeur partiel) puis par trith\u00e9rapie \u00e0 base de t\u00e9laprevir (ATU nominative, r\u00e9pondeur rechuteur). Sa consommation d\u2019alcool a toujours \u00e9t\u00e9 excessive, avec de courtes p\u00e9riodes d\u2019abstinence. L\u2019\u00e9tat h\u00e9patique s\u2019est progressivement d\u00e9grad\u00e9 avec constitution d\u2019une cirrhose en 2009, puis rupture de varices \u0153sophagiennes en 2012,2013 et 2014. Le suivi h\u00e9patologique et addictologique a \u00e9t\u00e9 chaotique avec une absence de suivi entre 2014 et 2016. Le patient est retrouv\u00e9 et repris en charge par l\u2019\u00e9quipe mobile h\u00e9patites en 2016. L e dossier du patient est pr\u00e9sent\u00e9 en RCP avec les \u00e9l\u00e9ments suivants :  cirrhose virale C et  alcoolique non sevr\u00e9e Child B (TP 55%, albumine 28g, bilirubine 45 micromoles\/l)  avec hypertension portale s\u00e9v\u00e8re chez un homme de 52 ans SDF. La charge virale \u00e9tait faible mesur\u00e9e \u00e0 3870 UI. Un traitement de 12 semaines par ombitasvir\/partiaprevir\/ritonavir et ribavirine est propos\u00e9, associ\u00e9 \u00e0 accompagnement social renforc\u00e9 et  h\u00e9bergement d\u2019urgence. Les co-m\u00e9dications comprenaient propranolol et esom\u00e9prazole. Apr\u00e8s 2 semaines, le patient est expuls\u00e9 de la structure d\u2019h\u00e9bergement suite \u00e0 une alcoolisation massive et le traitement antiviral C est interrompu. La charge virale C r\u00e9alis\u00e9e 1 mois et 3 mois apr\u00e8s la fin du traitement est n\u00e9gative. Le patient cumulait pourtant les facteurs de mauvaise r\u00e9ponse virologique : sexe masculin, \u00e2ge sup\u00e9rieur \u00e0  50 ans, pr\u00e9traitement par interf\u00e9ron ribavirine et antiprot\u00e9ases, consommation excessive d\u2019alcool, cirrhose CHILD B, compliance al\u00e9atoire lors des pr\u00e9c\u00e9dents traitements, dur\u00e9e de traitement courte, albumine basse et traitement par IPP. Seule la charge virale initiale faible pourrait constituer un param\u00e8tre favorable chez un patient en situation d\u2019\u00e9chec programm\u00e9 in\u00e9vitable !<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2017 ORTIZ Maria Del Carmen, REMY Andr\u00e9-Jean, HERVET J\u00e9r\u00e9my, BOUVHKIRA Hakim, MONTABONE Hakim, POURRET Anne H\u00e9patologie &#8211; \u00a02017-05-11 &#8211;\u00a0CC &#8211; ________________________________ Les facteurs de mauvaise r\u00e9ponse au traitement de l\u2019h\u00e9patite C sont connus et peuvent expliquer les \u00e9checs des nouveaux traitements antiviraux directs, m\u00eame avec des taux de r\u00e9ponses sup\u00e9rieurs \u00e0 95%. Mr A pr\u00e9sente [&hellip;]<\/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":[28],"class_list":["post-2079","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-28"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>H\u00e9patite C trait\u00e9e : bonne ou mauvaise r\u00e9ponse ? 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