164
Kronik HCV
NS5B polimeraz inhibitörlerinin iki sınıfı vardır. Bunlar nükleos(t)id polimeraz
inhibitörleri (NI) ve nonnükleos(t)id polimeraz inhibitörleridir (NNI). HCV’nin
tüm genotiplerine karşı etkilidirler ve yüksek genetik bariyere sahiptirler. Po-
limerazın korunmuş olan aktif bölgesinde oluşacak mutasyonların dirence
neden olabileceği düşünülse de, mutant HCV’nin viral dayanıklılığı azaldığı
için NI’lere direnç genel olarak oldukça düşüktür. Sofosbuvir, FDA onayı alan
bir DAA’dır ve NS5B polimerazıdır. NNI’lerine direnç, NI’lere karşı gelişen di-
rence göre çok daha yüksektir
(Şekil 7)
.
Kaynaklar
1.
Swain MG, Lai MY, Shiffman ML, et al.: A sustained virologic response is durable
in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin.
Gastroenterology. 2010;139:1593-1601
2.
Manns MP, Pockros PJ, Norkrans G, et al.: Long-term clearance of hepatitis C virus
following interferon-2b or peginterferon-2b, alone or in combination with ribavirin. J
Viral Hepat. 2013; 20:524-529
3.
Vera-Llonch M, Martin M, Aggarwal J, et al.: Health-related quality of life in genotype
1 treatment-naive chronic hepatitis C patients receiving telaprevir combination
treatment in the ADVANCE study. Aliment Pharmacol Ther. 2013;38:124-133
4.
Veldt B, Heathcote E, Wedemeyer H, et al.: Sustained virologic response and clinical
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5.
Cardoso AC, Moucari R, Figueiredo-Mendes C, et al.: Impact of peginterferon and
ribavirin therapy on hepatocellular carcinoma: Incidence and survival in hepatitis C
patients with advanced fibrosis. J Hepatol. 2010; 52:652-657
6.
Van der Meer AJ, Wedemeyer H, Feld JJ, et al.: Is there sufficient evidence to
recommend antiviral therapy in hepatitis C? J Hepatol. 2013
7.
Ogawa E, Furusyo N, Kajiwara E, et al.: Efficacy of pegylated interferon alpha-2b and
ribavirin treatment on the risk of hepatocellular carcinoma in patients with chronic
hepatitis C: A prospective, multicenter study. J Hepatol. 2013; 58:495-501
8.
Van der Meer AJ, Veldt BJ, Feld JJ, et al.: Association between sustained virological
response and all-cause mortality among patients with chronic hepatitis C and
advanced hepatic fibrosis.JAMA. 2012 ;308:2584-2593
9.
Di Bisceglie AM, Shiffman ML, Everson GT, et al.: Prolonged therapy of advanced
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10.
D’Ambrasio R, Aghemo A,Rumi MG et al.A morphometric and ımmunohistochemical
study to assess the benefit of a sustained virological response in hepatitis C virus
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Shiffman ML.Chronic Hepatitis C Advances in Treatment Promise For The Future.
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Gramenzi A,Andreone P,Fiorino S,et al.Impact of interferon therapy on the naturel
history of hepatitis C virus related cirrhosis. Gut.2001;48:843-848.
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Mazzella G, Accogli E, Sottili S,et al.Algha interferon treatment may prevent
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