{"id":18631,"date":"2023-04-12T13:53:41","date_gmt":"2023-04-12T06:53:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18631"},"modified":"2023-04-12T18:54:35","modified_gmt":"2023-04-12T11:54:35","slug":"phac-do-dieu-tri-viem-gan-virus-c-cua-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/phac-do-dieu-tri-viem-gan-virus-c-cua-bo-y-te\/","title":{"rendered":"Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan virus C c\u1ee7a B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

Vi\u00eam gan C (hay c\u00f2n g\u1ecdi l\u00e0 vi\u00eam gan si\u00eau vi C) l\u00e0 m\u1ed9t b\u1ec7nh nhi\u1ec5m tr\u00f9ng gan do virus vi\u00eam gan C (HCV) g\u00e2y ra. B\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u1ed5n th\u01b0\u01a1ng gan v\u00e0 d\u1eabn \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nghi\u00eam tr\u1ecdng. Theo \u01b0\u1edbc t\u00ednh c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi n\u0103m 2017, tr\u00ean th\u1ebf gi\u1edbi c\u00f3 71 tri\u1ec7u ng\u01b0\u1eddi b\u1ecb vi\u00eam gan vi r\u00fat C m\u1ea1n trong \u0111\u00f3 14 tri\u1ec7u ng\u01b0\u1eddi s\u1ed1ng \u1edf khu v\u1ef1c T\u00e2y Th\u00e1i B\u00ecnh D\u01b0\u01a1ng, n\u01a1i vi\u00eam gan vi r\u00fat l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong trong s\u1ed1 c\u00e1c b\u1ec7nh truy\u1ec1n nhi\u1ec5m. Vi\u00eam gan C hi\u1ec7n ch\u01b0a c\u00f3 v\u1eafc xin ph\u00f2ng ng\u1eeba, nh\u01b0ng c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u0111\u1ec3 ng\u0103n ng\u1eeba t\u1ed5n th\u01b0\u01a1ng gan v\u00e0 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m.<\/strong><\/p>\n

\"Virus
Virus vi\u00eam gan C c\u00f3 th\u1ec3 g\u00e2y ung th\u01b0 gan n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb<\/figcaption><\/figure>\n

1. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

B\u1ea3ng 1. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C m\u1ea1n \u1edf ng\u01b0\u1eddi \u2265 18 tu\u1ed5i kh\u00f4ng c\u00f3 x\u01a1 gan, x\u01a1 gan c\u00f2n b\u00f9 v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u1ea7n \u0111\u1ea7u<\/strong><\/p>\n\n\n\n\n\n\n\n\n
Thu\u1ed1c DAA<\/strong><\/td>\nKi\u1ec3u gen 1,4<\/strong><\/td>\nKi\u1ec3u gen 2<\/strong><\/td>\nKi\u1ec3u gen 3<\/strong><\/td>\nKi\u1ec3u gen 5, 6<\/strong><\/td>\n<\/tr>\n
SOF\/VEL<\/td>\n\u0110i\u1ec1u tr\u1ecb t\u1ea5t c\u1ea3 c\u00e1c ki\u1ec3u gen trong 12 tu\u1ea7n<\/td>\n<\/tr>\n
SOF\/DAC1<\/sup><\/td>\n\u0110i\u1ec1u tr\u1ecb t\u1ea5t c\u1ea3 c\u00e1c ki\u1ec3u gen trong 12 tu\u1ea7n<\/td>\n<\/tr>\n
SOF\/LDV<\/td>\n12 tu\u1ea7n<\/td>\nKh\u00f4ng<\/td>\nKh\u00f4ng<\/td>\n12 tu\u1ea7n<\/td>\n<\/tr>\n
GLE\/PIB2<\/sup><\/td>\n\u0110i\u1ec1u tr\u1ecb t\u1ea5t c\u1ea3 c\u00e1c ki\u1ec3u gen trong 8 tu\u1ea7n<\/td>\n<\/tr>\n
GRZ\/EBV3<\/sup><\/td>\n12 tu\u1ea7n<\/td>\nKh\u00f4ng<\/td>\nKh\u00f4ng<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

T\u1ef7 l\u1ec7 kh\u1ecfi (SVR12) \u1edf ng\u01b0\u1eddi vi\u00eam gan C ki\u1ec3u gen 3 c\u00f3 x\u01a1 gan l\u00e0 kho\u1ea3ng 80% khi \u0111i\u1ec1u tr\u1ecb v\u1edbi ph\u00e1c \u0111\u1ed3 c\u00f3 SOF\/DAC v\u00e0 tr\u00ean 90% khi \u0111i\u1ec1u tr\u1ecb v\u1edbi ph\u00e1c \u0111\u1ed3 SOF\/VEL.<\/p>\n

Thu\u1ed1c ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd t\u1ea1i Vi\u1ec7t Nam v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n. Ch\u1ec9 \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n khi c\u00e1c thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c B\u1ed9 Y t\u1ebf c\u1ea5p ph\u00e9p.<\/p>\n

L\u01b0u \u00fd: Li\u1ec1u l\u01b0\u1ee3ng c\u1ee7a c\u00e1c thu\u1ed1c DAA (Ph\u1ee5 l\u1ee5c 3)<\/p>\n

B\u1ea3ng 2. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C m\u1ea1n cho ng\u01b0\u1eddi b\u1ec7nh \u2265 18 tu\u1ed5i c\u00f3 x\u01a1 gan m\u1ea5t b\u00f9 v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u1ea7n \u0111\u1ea7u<\/strong><\/p>\n

(Child Pugh B ho\u1eb7c C)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
Thu\u1ed1c DAA<\/strong><\/td>\nKi\u1ec3u gen 1,4<\/strong><\/td>\nKi\u1ec3u gen 2<\/strong><\/td>\nKi\u1ec3u gen 3<\/strong><\/td>\nKi\u1ec3u gen 5,6<\/strong><\/td>\n<\/tr>\n
SOF\/VEL<\/td>\n\u0110i\u1ec1u tr\u1ecb t\u1ea5t c\u1ea3 c\u00e1c ki\u1ec3u gen trong 24 tu\u1ea7n<\/td>\n<\/tr>\n
SOF\/VEL\/RBV<\/td>\n\u0110i\u1ec1u tr\u1ecb t\u1ea5t c\u1ea3 c\u00e1c ki\u1ec3u gen trong 12 tu\u1ea7n<\/td>\n<\/tr>\n
SOF\/LDV<\/td>\n24 tu\u1ea7n<\/td>\nKh\u00f4ng<\/td>\nKh\u00f4ng<\/td>\n24 tu\u1ea7n<\/td>\n<\/tr>\n
SOF\/LDV\/RBV<\/td>\n12 tu\u1ea7n<\/td>\nKh\u00f4ng<\/td>\nKh\u00f4ng<\/td>\n12 tu\u1ea7n<\/td>\n<\/tr>\n
SOF\/DAC1<\/sup><\/td>\n24 tu\u1ea7n<\/td>\n24 tu\u1ea7n<\/td>\n24 tu\u1ea7n<\/td>\n24 tu\u1ea7n<\/td>\n<\/tr>\n
SOF\/DAC\/RBV1<\/sup><\/td>\n12 tu\u1ea7n<\/td>\n12 tu\u1ea7n<\/td>\n12 tu\u1ea7n<\/td>\n12 tu\u1ea7n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

T\u1ef7 l\u1ec7 kh\u1ecfi (SVR12) \u1edf ng\u01b0\u1eddi vi\u00eam gan C ki\u1ec3u gen 3 c\u00f3 x\u01a1 gan l\u00e0 kho\u1ea3ng 80% khi \u0111i\u1ec1u tr\u1ecb v\u1edbi ph\u00e1c \u0111\u1ed3 c\u00f3 SOF\/DAC v\u00e0 tr\u00ean 90% khi \u0111i\u1ec1u tr\u1ecb v\u1edbi ph\u00e1c \u0111\u1ed3 c\u00f3 SOF\/VEL.<\/p>\n

L\u01b0u \u00fd:<\/p>\n

– Li\u1ec1u l\u01b0\u1ee3ng c\u1ee7a c\u00e1c thu\u1ed1c DAA (Ph\u1ee5 l\u1ee5c 3)<\/p>\n

– \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u RBV theo c\u00e2n n\u1eb7ng, m\u1ee9c \u0111\u1ed9 thi\u1ebfu m\u00e1u v\u00e0 m\u1ee9c \u0111\u1ed9 suy th\u1eadn (Ph\u1ee5 l\u1ee5c 4)<\/p>\n

– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng GLE, GRZ, VOX cho ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan m\u1ea5t b\u00f9<\/p>\n

2. \u0110i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C \u1edf m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t<\/strong><\/h2>\n

2.1. \u0110i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C cho tr\u1ebb em kh\u00f4ng x\u01a1 gan v\u00e0 x\u01a1 gan c\u00f2n b\u00f9<\/strong><\/h3>\n

* Tr\u1ebb t\u1eeb 12 -17 tu\u1ed5i:<\/strong>\u00a0\u0111i\u1ec1u tr\u1ecb theo b\u1ea3ng sau v\u1edbi li\u1ec1u nh\u01b0 c\u1ee7a ng\u01b0\u1eddi l\u1edbn<\/p>\n

B\u1ea3ng 3. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C m\u1ea1n cho tr\u1ebb 12 -17 tu\u1ed5i kh\u00f4ng x\u01a1 gan v\u00e0 x\u01a1 gan c\u00f2n b\u00f9<\/strong><\/p>\n\n\n\n\n
Ph\u00e1c \u0111\u1ed3<\/strong><\/td>\nSOF\/VEL<\/td>\nGLE\/PIB<\/td>\nSOF\/LED<\/td>\n<\/tr>\n
Th\u1eddi gian<\/strong><\/td>\n12 tu\u1ea7n<\/td>\n8 tu\u1ea7n<\/td>\n12 tu\u1ea7n<\/p>\n

(ch\u1ec9 d\u00f9ng cho ki\u1ec3u gen 1, 4, 5, 6)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

* Tr\u1ebb t\u1eeb 3 -11 tu\u1ed5i<\/strong><\/p>\n

– SOF\/VEL: li\u1ec1u d\u1ef1a v\u00e0o c\u00e2n n\u1eb7ng<\/p>\n

Tr\u1ebb < 17 kg: SOF 150mg v\u00e0 VEL 37,5mg\/ng\u00e0y x 12 tu\u1ea7n<\/p>\n

Tr\u1ebb \u2265 17 kg: SOF 200mg v\u00e0 VEL 50mg\/ng\u00e0y x 12 tu\u1ea7n<\/p>\n

– SOF\/LED: d\u00f9ng cho ki\u1ec3u gen 1, 4, 5, 6<\/p>\n

Tr\u1ebb < 17 kg: SOF 150mg\/LED 33,75mg\/ng\u00e0y\u00a0x\u00a012 tu\u1ea7n<\/p>\n

Tr\u1ebb 17-35 kg: SOF 200mg\/LED 45mg\/ng\u00e0y\u00a0x\u00a012 tu\u1ea7n<\/p>\n

Tr\u1ebb > 35 kg: SOF 400mg\/LED 90mg\/ng\u00e0y\u00a0x\u00a012 tu\u1ea7n<\/p>\n

– GLE\/PIB:<\/p>\n

Tr\u1ebb 12 – 19 kg: GLE 150mg v\u00e0 PIB 60mg\/ng\u00e0y x 12 tu\u1ea7n<\/p>\n

Tr\u1ebb 20 – 29 kg: GLE 200mg v\u00e0 PIB 80mg\/ng\u00e0y x 12 tu\u1ea7n<\/p>\n

Tr\u1ebb 30 – 44 kg: GLE 250mg v\u00e0 PIB 100mg\/ng\u00e0y x 12 tu\u1ea7n<\/p>\n

L\u01b0u \u00fd: GLE\/PIB ch\u01b0a c\u00f3 t\u1ea1i Vi\u1ec7t Nam<\/p>\n

* Tr\u1ebb d\u01b0\u1edbi 3 tu\u1ed5i:<\/strong>\u00a0Tr\u00ec ho\u00e3n \u0111i\u1ec1u tr\u1ecb cho \u0111\u1ebfn khi tr\u1ebb \u0111\u1ee7 3 tu\u1ed5i<\/p>\n

2.2. Ng\u01b0\u1eddi b\u1ec7nh vi\u00eam gan vi r\u00fat C \u0111\u1ed3ng nhi\u1ec5m HIV<\/strong><\/h3>\n

Ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m HCV\/HIV \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ARV ngay khi ph\u00e1t hi\u1ec7n nhi\u1ec5m HIV v\u00e0 \u0111i\u1ec1u tr\u1ecb HCV khi CD4 t\u1eeb 200 t\u1ebf b\u00e0o\/mm3<\/sup>\u00a0tr\u1edf l\u00ean ho\u1eb7c t\u1ea3i l\u01b0\u1ee3ng HIV d\u01b0\u1edbi ng\u01b0\u1ee1ng \u1ee9c ch\u1ebf. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 x\u01a1 h\u00f3a t\u1eeb F2 tr\u1edf l\u00ean, \u0111i\u1ec1u tr\u1ecb HCV ngay khi dung n\u1ea1p \u0111i\u1ec1u tr\u1ecb ARV.<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C cho ng\u01b0\u1eddi nhi\u1ec5m HIV gi\u1ed1ng nh\u01b0 ng\u01b0\u1eddi b\u1ec7nh vi\u00eam gan vi r\u00fat C kh\u00f4ng nhi\u1ec5m HIV<\/p>\n

L\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ARV v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C t\u1ed1i \u01b0u \u0111\u1ec3 tr\u00e1nh t\u01b0\u01a1ng t\u00e1c thu\u1ed1c (Ph\u1ee5 l\u1ee5c 5), n\u1ebfu c\u1ea7n thi\u1ebft ph\u1ea3i \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u DAA.<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh \u0111i\u1ec1u tr\u1ecb HIV b\u1eb1ng ph\u00e1c \u0111\u1ed3 tenofovir\/lamivudin\/dolutegravir (TDF\/3TC\/DTG ho\u1eb7c TLD): \u0111i\u1ec1u tr\u1ecb nh\u01b0 ng\u01b0\u1eddi vi\u00eam gan vi r\u00fat C kh\u00f4ng nhi\u1ec5m HIV<\/p>\n

L\u01b0u \u00fd:<\/strong>\u00a0Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh ph\u00e1c \u0111\u1ed3 SOF\/VEL ho\u1eb7c SOF\/LDV khi m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 60 ml\/ph\u00fat\/1,73m2<\/sup><\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh \u0111i\u1ec1u tr\u1ecb HIV b\u1eb1ng ph\u00e1c \u0111\u1ed3 kh\u00e1c TLD:<\/p>\n

+ Chuy\u1ec3n sang ph\u00e1c \u0111\u1ed3 TLD n\u1ebfu c\u00f3 th\u1ec3 tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb HCV<\/p>\n

+ Ng\u01b0\u1eddi b\u1ec7nh \u0111ang \u0111i\u1ec1u tr\u1ecb HIV b\u1eb1ng ph\u00e1c \u0111\u1ed3 c\u00f3 efavirenz (EFV), nevirapine (NVP): \u01b0u ti\u00ean s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 SOF\/DAC: \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u DAC l\u00ean 90 mg<\/p>\n

+ Ng\u01b0\u1eddi b\u1ec7nh \u0111ang \u0111i\u1ec1u tr\u1ecb HIV b\u1eb1ng ph\u00e1c \u0111\u1ed3 c\u00f3 loperavir\/ritonavir (LPV\/r): \u01b0u ti\u00ean s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3: SOF\/VEL; SOF\/DAC.<\/p>\n

Ph\u00e1c \u0111\u1ed3 thay th\u1ebf: SOF\/LDV. Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh ph\u00e1c \u0111\u1ed3 c\u00f3 LDV khi m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 60 ml\/ph\u00fat\/1,73m2<\/sup>.<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh \u0111ang \u0111i\u1ec1u tr\u1ecb HIV b\u1eb1ng ph\u00e1c \u0111\u1ed3 c\u00f3 atazanavir (ATV): \u01b0u ti\u00ean s\u1eed d\u1ee5ng SOF\/DAC: \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u DAC xu\u1ed1ng 30 mg<\/p>\n

Ph\u00e1c \u0111\u1ed3 thay th\u1ebf: SOF\/LDV. Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh ph\u00e1c \u0111\u1ed3 c\u00f3 LDV khi m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 60 ml\/ph\u00fat\/1,73m2<\/sup>.<\/p>\n

* L\u01b0u \u00fd kh\u00f4ng ph\u1ed1i h\u1ee3p c\u00e1c<\/strong>\u00a0ph\u00e1c \u0111\u1ed3 sau \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng nhi\u1ec5m HCV\/HIV<\/p>\n

– SOF\/VEL kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi EFV, NVP<\/p>\n

– SOF\/VEL\/VOX kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi EFV, NVP, ATV\/r, LPV\/r<\/p>\n

– RBV kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi AZT<\/p>\n

– ELB\/GRZ kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi EFV, NVP ho\u1eb7c b\u1ea5t k\u1ef3 PI<\/p>\n

– GLE\/PIB kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi EFV, NVP, LPV, ATV ho\u1eb7c ph\u00e1c \u0111\u1ed3 ARV c\u00f3 ritonavir<\/p>\n

2.3. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m HCV\/HBV<\/strong><\/h3>\n

– Ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m HCV\/HBV \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c ph\u00e1c \u0111\u1ed3 kh\u00e1ng HCV nh\u01b0 ng\u01b0\u1eddi nhi\u1ec5m HCV \u0111\u01a1n thu\u1ea7n<\/p>\n

– Ng\u01b0\u1eddi \u0111\u1ed3ng nhi\u1ec5m HCV\/HBV \u0111\u1ee7 ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb HBV th\u00ec \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi HBV v\u00e0 HCV (ch\u00fa \u00fd t\u01b0\u01a1ng t\u00e1c thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t gi\u1eefa TDF v\u00e0 SOF- Ph\u1ee5 l\u1ee5c 5)<\/p>\n

– Ng\u01b0\u1eddi \u0111\u1ed3ng nhi\u1ec5m HCV\/HBV m\u00e0 ch\u01b0a \u0111\u1ee7 ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb HBV th\u00ec \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng HBV b\u1eb1ng thu\u1ed1c kh\u00e1ng HBV (NA: nucleot(s)ide analogues) khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb thu\u1ed1c DAA cho \u0111\u1ebfn khi k\u1ebft th\u00fac DAA t\u1ed1i thi\u1ec3u 12 tu\u1ea7n v\u00e0 theo d\u00f5i \u0111\u1ecbnh k\u1ef3 n\u1ebfu ng\u01b0ng \u0111i\u1ec1u tr\u1ecb NA<\/p>\n

– Nguy c\u01a1 t\u00e1i ho\u1ea1t HBV \u1edf ng\u01b0\u1eddi b\u1ecb vi\u00eam gan vi r\u00fat C c\u00f3 HBsAg \u00e2m t\u00ednh, anti-HBs \u00e2m t\u00ednh nh\u01b0ng anti-HBc d\u01b0\u01a1ng t\u00ednh r\u1ea5t th\u1ea5p trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c DAA. Nh\u1eefng ng\u01b0\u1eddi n\u00e0y kh\u00f4ng \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng NA, ch\u1ec9 theo d\u00f5i ALT, AST m\u1ed7i 4-8 tu\u1ea7n trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb thu\u1ed1c DAA v\u00e0 trong 12 tu\u1ea7n sau khi k\u1ebft th\u00fac \u0111i\u1ec1u tr\u1ecb DAA. N\u1ebfu ALT, AST t\u0103ng n\u00ean l\u00e0m th\u00eam x\u00e9t nghi\u1ec7m HBsAg v\u00e0 HBV DNA \u0111\u1ec3 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n HBV t\u00e1i ho\u1ea1t. \u0110i\u1ec1u tr\u1ecb NA n\u1ebfu c\u00f3 b\u1eb1ng ch\u1ee9ng HBV t\u00e1i ho\u1ea1t (HBsAg d\u01b0\u01a1ng v\u00e0\/ho\u1eb7c HBV DNA ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c).<\/p>\n

2.4<\/strong>. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh th\u1eadn m\u1ea1n<\/strong><\/h3>\n

– Ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh (m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn > 30 ml\/ph\u00fat\/1,73m2<\/sup>) ho\u1eb7c m\u1ee9c \u0111\u1ed9 n\u1eb7ng (m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 30ml\/ph\u00fat\/1,73m2<\/sup>) bao g\u1ed3m ng\u01b0\u1eddi b\u1ec7nh l\u1ecdc m\u00e1u, ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00e1c ph\u00e1c \u0111\u1ed3 ph\u00f9 h\u1ee3p m\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c DAA nh\u01b0 GLE\/PIB, SOF\/VEL, SOF\/DAC cho t\u1ea5t c\u1ea3 ki\u1ec3u gen v\u00e0 ELB\/GRZ cho ki\u1ec3u gen 1 v\u00e0 4<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan m\u1ea5t b\u00f9 c\u00f3 suy th\u1eadn nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh (m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn > 30 ml\/ph\u00fat\/1,73m2<\/sup>) n\u1ebfu \u0111i\u1ec1u tr\u1ecb ph\u00e1c \u0111\u1ed3 SOF\/VEL 12 tu\u1ea7n c\u00f3 RBV th\u00ec li\u1ec1u RBV b\u1eaft \u0111\u1ea7u l\u00e0 600 mg, v\u00e0 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u RBV t\u00f9y theo \u0111\u1ed9 dung n\u1ea1p v\u00e0 hemoglobin<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan m\u1ea5t b\u00f9 c\u00f3 suy th\u1eadn n\u1eb7ng (m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 30 ml\/ph\u00fat\/1,73m2<\/sup>) n\u00ean \u0111i\u1ec1u tr\u1ecb ph\u00e1c \u0111\u1ed3 SOF\/VEL 24 tu\u1ea7n kh\u00f4ng c\u00f3 RBV<\/p>\n

2.5. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m lao\/HCV<\/strong><\/h3>\n

– C\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb lao ti\u1ebfn tri\u1ec3n tr\u01b0\u1edbc, khi \u1ed5n \u0111\u1ecbnh th\u00ec \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb nh\u01b0 ng\u01b0\u1eddi b\u1ec7nh vi\u00eam gan vi r\u00fat C \u0111\u01a1n nhi\u1ec5m.<\/p>\n

– Khi \u0111i\u1ec1u tr\u1ecb lao v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat C l\u01b0u \u00fd kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi rifampicine v\u1edbi c\u00e1c thu\u1ed1c DAA (Ph\u1ee5 l\u1ee5c 5).<\/p>\n

T\u00f3m l\u1ea1i, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb vi\u00eam gan C l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng gan v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 qu\u1ea3n l\u00fd th\u00edch h\u1ee3p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m.<\/p>\n

\u0110\u1ec3 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ea1i vi\u1ec7n, Qu\u00fd kh\u00e1ch vui l\u00f2ng b\u1ea5m s\u1ed1\u00a0HOTLINE<\/strong><\/a>\u00a0ho\u1eb7c \u0111\u1eb7t l\u1ecbch tr\u1ef1c ti\u1ebfp\u00a0T\u1ea0I \u0110\u00c2Y<\/strong><\/a>. T\u1ea3i v\u00e0 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ef1 \u0111\u1ed9ng tr\u00ean\u00a0\u1ee9ng d\u1ee5ng MyVinmec<\/a> \u0111\u1ec3 qu\u1ea3n l\u00fd, theo d\u00f5i l\u1ecbch v\u00e0 \u0111\u1eb7t h\u1eb9n m\u1ecdi l\u00fac m\u1ecdi n\u01a1i ngay tr\u00ean \u1ee9ng d\u1ee5ng. https:\/\/youtu.be\/sJAOMNkNpz8<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam gan C (hay c\u00f2n g\u1ecdi l\u00e0 vi\u00eam gan si\u00eau vi C) l\u00e0 m\u1ed9t b\u1ec7nh nhi\u1ec5m tr\u00f9ng gan do virus vi\u00eam gan C (HCV) g\u00e2y ra. B\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u1ed5n th\u01b0\u01a1ng gan v\u00e0 d\u1eabn \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nghi\u00eam tr\u1ecdng. Theo \u01b0\u1edbc t\u00ednh c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi n\u0103m […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"\nPh\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan virus C c\u1ee7a B\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam gan C hi\u1ec7n ch\u01b0a c\u00f3 v\u1eafc xin ph\u00f2ng ng\u1eeba, nh\u01b0ng c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u0111\u1ec3 ng\u0103n ng\u1eeba t\u1ed5n th\u01b0\u01a1ng gan. 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