1
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Reghunathan M, Camacho JM, Blum J, Sendek G, Luong TT, Chen S, Bradford P, Llaneras J, Butler PD, Gosman AA. A SWOT Analysis of Hot Topics in Plastic Surgery Resident Education: Consensus From the ACAPS 10th Annual Winter Meeting. Plast Reconstr Surg Glob Open 2023; 11:e5461. [PMID: 38098955 PMCID: PMC10721128 DOI: 10.1097/gox.0000000000005461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/17/2023] [Indexed: 12/17/2023]
Abstract
Background With the aim of facilitating a critical self-reflection on how to align plastic surgery education with making excellent plastic surgeons, a rotating small-group session followed by live interactive audience polling was used to perform a SWOT (strengths, weaknesses, opportunities, and threats) analysis at the 10th Annual American Council of Academic Plastic Surgeons Winter Meeting. Methods The final day of the conference included a 3-hour session of rotating small groups followed by live interactive audience polls discussing the following six relevant educational topics: the Plastic Surgery Common Application and resident selection, aesthetic surgery education, leadership development and business education, embedded fellowships and focused training, mentorship, and faculty retention. Results A total of 60 individuals participated in the activity. A SWOT analysis was successfully performed for each educational topic, and a minimum of four opportunities were identified per topic to help guide future endeavors. Examples of opportunities include releasing recommendations for the implementation of holistic review; developing formal guidelines for aesthetic surgery education in residency via collaboration between ACAPS, American Society of Plastic Surgeons, and The Aesthetic Society; creating extended focused elective rotations; integrating business education into formal curricula for all training levels; enforcing transparency regarding position expectations and offerings including salary, call schedule, and current challenges; and more. Conclusion The results of this study will help guide future initiatives by the ACAPS to improve resident education and academic retention.
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Affiliation(s)
- Meera Reghunathan
- From the Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, Ca
| | | | - Jessica Blum
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, Wis
| | - Gabriela Sendek
- From the Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, Ca
| | - Thanh T. Luong
- From the Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, Ca
| | - Shirley Chen
- Vanderbilt University School of Medicine, Nashville, Tenn
| | - Perry Bradford
- Department of Plastic Surgery, University of Virginia Health, Charlottesville, Va
| | - Jason Llaneras
- From the Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, Ca
| | - Paris D. Butler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Amanda A. Gosman
- From the Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, Ca
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Huang EY, Zhao B, Llaneras J, Liu S, Stringfield SB, Abbadessa B, Lopez NE, Ramamoorthy SL, Parry LA, Gosman AA, Dobke M, Eisenstein S. Autologous Fat Grafting: an Emerging Treatment Option for Complex Anal Fistulas. J Gastrointest Surg 2023:10.1007/s11605-023-05719-4. [PMID: 37268827 PMCID: PMC10366023 DOI: 10.1007/s11605-023-05719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/20/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Autologous fat grafting (AFG) has shown promise in the treatment of complex wounds, with trials reporting good healing rates and safety profile. We aim to investigate the role of AFG in managing complex anorectal fistulas. METHODS This was a retrospective review of a prospectively maintained IRB-approved database. We examined the rates of symptom improvement, clinical closure of fistula tracts, recurrence, complications, and worsening fecal incontinence. Perianal disease activity index (PDAI) was obtained for patients undergoing combination of AFG and fistula plug treatment. RESULTS In total, 52 unique patients underwent 81 procedures, of which Crohn's was present in 34 (65.4%) patients. The majority of patients previously underwent more common treatments such as endorectal advancement flap or ligation of intersphincteric fistula tract. Fat-harvesting sites and processing technique were selected by the plastic surgeons based on availability of trunk fat deposits. When analyzing patients by their last procedure, 41 (80.4%) experienced symptom improvement, and 29 (64.4%) experienced clinical closure of all fistula tracts. Recurrence rate was 40.4%, and complication rate was 15.4% (7 postoperative abscesses requiring I&D and 1 bleeding episode ligated at bedside). The abdomen was the most common site of lipoaspirate harvest at 63%, but extremities were occasionally used. There were no statistically significant differences in outcomes when comparing single graft treatment to multiple treatments, Crohn's and non-Crohn's, different methods of fat preparation, and diversion. CONCLUSION AFG is a versatile procedure that can be done in conjunction with other therapies and does not interfere with future treatments if recurrence occurs. It is a promising and affordable method to safely address complex fistulas.
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Affiliation(s)
- Estella Y Huang
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Beiqun Zhao
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Jason Llaneras
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Shanglei Liu
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Sarah B Stringfield
- Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Benjamin Abbadessa
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Nicole E Lopez
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Sonia L Ramamoorthy
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Lisa A Parry
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Amanda A Gosman
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Marek Dobke
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Samuel Eisenstein
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, CA, USA.
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3
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Abstract
BACKGROUND Students who are underrepresented in medicine experience limited access to mentorship throughout medical school and when applying to plastic surgery residency. This study describes the creation, growth, and results of the multi-institutional West Coast Plastic Surgery Mentorship Program (WCPSMP), specifically reflecting on barriers to implementation and room for future improvement. METHODS Students were eligible to apply to the plastic surgery mentorship program if they were first-, second-, or third-year medical students in a US medical school interested in plastic surgery. Preference was given to students who are (1) underrepresented-in-medicine racial/ethnic minorities; (2) first generation, low income; (3) lesbian, gay, bisexual, transgender, queer; and/or (4) without a home integrated plastic surgery program. Preprogram and postprogram surveys were analyzed. RESULTS The 2021-2022 cycle of the WCPSMP included 30 resident mentors and 30 resident mentees, with a 1:1 mentor-to-mentee relationship. The second annual Mentor-Mentee Day was hosted on June 25, 2022, in San Diego, California, with attendance from 18 mentees. There was a 63% response rate in the presurvey and postsurvey. Most students endorsed gaining didactic skills, technical skills, and networking, but only a few gained research opportunities. CONCLUSION The WCPSMP is a promising venue to offer underrepresented medical students valuable resident mentorship, as well as acquire surgical knowledge and skills. Further development of the program includes implementing a curriculum for residents on how to be an effective mentor and offering more research opportunities.
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Affiliation(s)
- Meera Reghunathan
- From the Division of Plastic Surgery, Department of Surgery, UC San Diego, San Diego, CA
| | - Jason Llaneras
- From the Division of Plastic Surgery, Department of Surgery, UC San Diego, San Diego, CA
| | | | - Amanda Gosman
- From the Division of Plastic Surgery, Department of Surgery, UC San Diego, San Diego, CA
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4
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Llaneras J, Klapp JM, Boyd JB, Granzow J, Moazzez A, Ozao-Choy JJ, Dauphine C, Goldberg MT. Post-Mastectomy Patients in an Urban Safety-Net Hospital: How Do Safety-Net Hospital Breast Reconstruction Rates Compare to National Breast Reconstruction Rates? Am Surg 2021:31348211054071. [PMID: 34962166 DOI: 10.1177/00031348211054071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Breast reconstruction (BR) has documented psychological benefits following mastectomy. Yet, racial/ethnic minority groups have lower reported rates of BR. We sought to evaluate the rate, type, and outcome of BR in a racially and ethnically diverse population within a safety-net hospital system. METHODS All patients who underwent mastectomy between October 2015 and July 2019 at Harbor-UCLA Medical Center were retrospectively examined. Rates and type of BR were analyzed according to patient characteristics (race/ethnicity, age, and body mass index), smoking status, cancer stage, and presence of diabetes mellitus. Breast reconstruction outcomes were also assessed. RESULTS Of the 259 patients that underwent mastectomy, 87 (33.6%) received BR. Immediate BR was performed in 79 (30.5%) patients and delayed BR in 8 (3.1%). Of the 79 patients with immediate BR, 58 (73.4%) received implant-based BR and 21 (26.5%) autologous tissue. The BR failure rate was 10%, all implant-based. Increasing age and smoking negatively impacted BR rates. Black (P =.331) and Hispanic (P =.132) ethnicity were not independent predictors of decreased breast reconstruction. CONCLUSION This study demonstrated that the rate, type, and quality of BR in this integrated safety-net hospital within a diverse population are comparable to national rates. When made available, historically underrepresented minority patients of Black and Hispanic ethnicity utilize BR.
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Affiliation(s)
- Jason Llaneras
- Division of Minimally Invasive Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jamie M Klapp
- Division of Minimally Invasive Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - J Brian Boyd
- Division of Minimally Invasive Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Joaquin Granzow
- Division of Minimally Invasive Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ashkan Moazzez
- Division of Minimally Invasive Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Junko J Ozao-Choy
- Division of Surgical Oncology, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Christine Dauphine
- Division of Surgical Oncology, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mytien T Goldberg
- Division of Minimally Invasive Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
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5
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Abstract
ABSTRACT Breast augmentation and reconstruction utilizing implants are among the most common plastic surgery procedures performed in the United States. A small proportion of these implants are removed each year. We report 2 cases where routine pathologic evaluation of capsulectomy specimens revealed squamous cell carcinoma associated with the breast implant capsule and discuss the possible pathogenesis of this unusual entity. Both patients had long-standing implants (>10 years) and presented with acute unilateral breast erythema and swelling. Intraoperatively, the capsules for both cases appeared thickened and calcified, containing extensive granulomatosis and keratinaceous debris invading into the chest wall. Extensive workup failed to find an occult primary. One patient died from a malignant pleural effusion secondary to tumor invasion during chemotherapy, and the second patient obtained stabilization of the mass after 5 weeks of chemotherapy but subsequently declined further surgical intervention. A thorough literature review was performed, and 5 similar reports were identified, involving 6 patients. All patients presented with similar clinical presentations as ours and had poor outcomes. The mean reporting age at diagnosis was 60 years, and the average time from initial implant to diagnosis was 25 years. Due to the small numbers of squamous cell carcinomas associated with breast implant capsules, the true association between the 2 is unknown. It is postulated that chronic inflammation/irritation from the breast implant and epithelialization of the capsule play a significant role in the disease process. This may represent a new entity of "chronic inflammatory capsular malignancies." Increased awareness of this entity may allow for earlier suspicion, diagnosis, and management.
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6
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Schmoke NR, Irizarry F, Llaneras J, Ruiz J, Ward-Peterson M. Stroke Outcomes In Sickle Cell Patients: From Children To Adults. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2017.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Perelló C, Carrión JA, Ruiz-Antorán B, Crespo J, Turnes J, Llaneras J, Lens S, Delgado M, García-Samaniego J, García-Paredes F, Fernández I, Morillas RM, Rincón D, Porres JC, Prieto M, Lázaro Ríos M, Fernández-Rodríguez C, Hermo JA, Rodríguez M, Herrero JI, Ruiz P, Fernández JR, Macías M, Pascasio JM, Moreno JM, Serra MÁ, Arenas J, Real Y, Jorquera F, Calleja JL. Effectiveness and safety of ombitasvir, paritaprevir, ritonavir ± dasabuvir ± ribavirin: An early access programme for Spanish patients with genotype 1/4 chronic hepatitis C virus infection. J Viral Hepat 2017; 24:226-237. [PMID: 27976491 DOI: 10.1111/jvh.12637] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022]
Abstract
Over the last 5 years, therapies for hepatitis C virus (HCV) infection have improved significantly, achieving sustained virologic response (SVR) rates of up to 100% in clinical trials in patients with HCV genotype 1. We investigated the effectiveness and safety of ombitasvir/paritaprevir/ritonavir±dasabuvir in an early access programme. This was a retrospective, multicentre, national study that included 291 treatment-naïve and treatment-experienced patients with genotype 1 or 4 HCV infection. Most patients (65.3%) were male, and the mean age was 57.5 years. The mean baseline viral load was 6.1 log, 69.8% had HCV 1b genotype, 72.9% had cirrhosis and 34.7% were treatment-naïve. SVR at 12 weeks posttreatment was 96.2%. Four patients had virological failure (1.4%), one leading to discontinuation. There were no statistical differences in virological response according to genotype or liver fibrosis. Thirty patients experienced serious adverse events (SAEs) (10.3%), leading to discontinuation in six cases. Hepatic decompensation was observed in five patients. Four patients died during treatment or follow-up, three of them directly related to liver failure. Multivariate analyses showed a decreased probability of achieving SVR associated with baseline albumin, bilirubin and Child-Pugh score B, and a greater probability of developing SAEs related to age and albumin. This combined therapy was highly effective in clinical practice with an acceptable safety profile and low rates of treatment discontinuation.
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Affiliation(s)
- C Perelló
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain.,CIBERehd, Madrid, Spain
| | - J A Carrión
- Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain
| | - B Ruiz-Antorán
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
| | - J Crespo
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.,Facultad de Medicina, Universidad de Cantabria, Santander, Spain
| | - J Turnes
- Complejo Hospitalario Universitario de Pontevedra and IISGS, Pontevedra, Spain
| | - J Llaneras
- Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - S Lens
- CIBERehd, Madrid, Spain.,Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - M Delgado
- Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | - I Fernández
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | - R M Morillas
- CIBERehd, Madrid, Spain.,Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - D Rincón
- CIBERehd, Madrid, Spain.,Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J C Porres
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M Prieto
- CIBERehd, Madrid, Spain.,Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Lázaro Ríos
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - J A Hermo
- Hospital Álvaro Cunqueiro, Vigo, Spain
| | - M Rodríguez
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J I Herrero
- CIBERehd, Madrid, Spain.,Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - P Ruiz
- Hospital Universitario Basurto, Bilbao, Spain
| | | | - M Macías
- Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - J M Pascasio
- CIBERehd, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J M Moreno
- Complejo Hospitalario Albacete, Albacete, Spain
| | - M Á Serra
- Hospital Universitario Clínico Valencia, INCLIVA, Valencia, Spain.,University of Valencia, Valencia, Spain
| | - J Arenas
- Hospital Universitario Donostia, Donostia, Spain
| | - Y Real
- Hospital Universitario La Princesa, Madrid, Spain
| | - F Jorquera
- CIBERehd, Madrid, Spain.,Complejo Asistencial de León, IBIOMED, León, Spain
| | - J L Calleja
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain.,CIBERehd, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
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8
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Llaneras J, Riveiro-Barciela M, Buti M, Esteban R. Hepatitis C virus genotype 4: Genotype 1's little brother. J Viral Hepat 2017; 24:4-12. [PMID: 27905173 DOI: 10.1111/jvh.12620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 12/14/2022]
Abstract
Treatment for hepatitis C virus genotype 4 infection has undergone a major advance over the past 5 years with the emergence of direct-acting antiviral agents. Previously, genotype 4 treatment had been limited to the combination of pegylated interferon and ribavirin, with low rates of sustained virological response. The combinations of new direct-acting agents have resulted in a radical improvement in hepatitis C therapy. Much of the currently available efficacy and safety information in the treatment of genotype 4 has been extrapolated through the results of genotype 1. In this report, we review the efficacy and safety data obtained in recent studies focusing on genotype 4 patients, including special populations, such as those with decompensated cirrhosis.
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Affiliation(s)
- J Llaneras
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - M Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Barcelona, Spain
| | - M Buti
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Barcelona, Spain
| | - R Esteban
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Barcelona, Spain
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9
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Llaneras J, Castells L, Santos B, Crespo M, Puig T, Esteban J, Esteban R. Removal from liver transplantation list of a hepatitis C virus-HIV co-infected patient after successful treatment with sofosbuvir and daclatasvir. Transpl Infect Dis 2016; 18:442-445. [DOI: 10.1111/tid.12538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 10/07/2015] [Accepted: 02/03/2016] [Indexed: 11/27/2022]
Affiliation(s)
- J. Llaneras
- Liver Unit; Internal Medicine Department; Hospital Universitari Vall Hebron, Barcelona; Univeristat Autònoma de Barcelona; Barcelona Spain
| | - L. Castells
- Liver Unit; Internal Medicine Department; Hospital Universitari Vall Hebron, Barcelona; Univeristat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Instituto de Salud Carlos III; Madrid Spain
| | - B. Santos
- Liver Unit; Internal Medicine Department; Hospital Universitari Vall Hebron, Barcelona; Univeristat Autònoma de Barcelona; Barcelona Spain
| | - M. Crespo
- Infectious Disease Unit; Internal Medicine Department; Hospital Universitari Vall Hebron; Barcelona Spain
| | - T. Puig
- HIV Unit; Internal Medicine Department; Hospital Universitari Arnau de Vilanova de Lleida; Universitat de Lleida; Lleida Spain
| | - J.I. Esteban
- Liver Unit; Internal Medicine Department; Hospital Universitari Vall Hebron, Barcelona; Univeristat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Instituto de Salud Carlos III; Madrid Spain
| | - R. Esteban
- Liver Unit; Internal Medicine Department; Hospital Universitari Vall Hebron, Barcelona; Univeristat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Instituto de Salud Carlos III; Madrid Spain
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10
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Abstract
Until recently, the standard of care for hepatitis C virus genotype 3 infection was response-guided therapy with pegylated interferon plus ribavirin for 16 to 48 or 72 weeks. The introduction of sofosbuvir plus ribavirin has revolutionized hepatitis C virus therapy. Nowadays, the recommend treatment regimen is a combination of sofosbuvir and a weight-based ribavirin dose for 24 weeks. For easy to treat patients (e.g. naïve or previously treated patients without cirrhosis), this combination achieves high sustained virologic response rates and is well tolerated. However, in treatment-experienced patients with cirrhosis, sustained virologic response is lower due to unknown reasons. The combination of two direct-acting antiviral agents, sofosbuvir and daclatasvir, for 12 weeks is also associated with low sustained virologic response rates in this special population, for whom new drugs and different strategies are now under evaluation. Currently, the high cost of all these drugs limits access to treatment in many countries.
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Affiliation(s)
- M Buti
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - J Llaneras
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - M Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - R Esteban
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Madrid, Spain
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