Allegato 1a -  Interferoni e farmaci correlati per il trattamento dell’infezione cronica da HCV e HBV. 

Il contesto regionale abruzzese appare caratterizzato da una significativa prevalenza di infezione cronica a scarso epatotropismo e transaminasi persistentemente normali. In merito a tale classe farmacologica, pertanto, la principale raccomandazione di carattere locale è che gli interferoni, peghilati e non, con autorizzazione alla rimborsabilità in soggetti con transaminasi normali, non siano impiegati se non a fronte di una adeguata documentazione di sussistente danno epatico, acquisita mediante esecuzione di esame Fibroscan e/o di biopsia epatica (1-10). In altri termini, data l’alta prevalenza di infezione cronica da virus epatite C a transaminasi persistentemente normali nella nostra area, e dato il costo elevato degli interferoni, sembra opportuno limitarne l’impiego ai casi in cui il danno epatico, anche moderato, sia effettivamente documentato (11-13). Per quanto riguarda il virus epatite B, alla luce delle recenti evidenze di letteratura a riguardo di una maggiore incidenza di carcinoma epatico nei soggetti con elevata e persistente replica virale, potrebbe essere considerato l’uso dell’interferone peghilato anche in assenza di una chiara documentazione di danno epatico a fronte di modesto movimento delle transaminasi, se la replica virale fosse persistentemente >106 UI/mL (14-16). Resta l’evidenza consolidata di letteratura, comunque, a supporto di una migliore risposta virologica nei soggetti con ipetransaminasemia sostenuta.

 

 

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