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고순영,최원혁 대한간학회 2018 Clinical and Molecular Hepatology(대한간학회지) Vol.24 No.4
The advent of novel, direct-acting antiviral (DAA) regimens for hepatitis C virus (HCV) infection has revolutionized its treatment by producing a sustained virologic response of more than 95% with few side effects and no comorbidities in the general population. Until recently, ideal DAA regimens have not been available to patients with severe renal impairment and end-stage renal disease because there are limited data on the pharmacokinetics, safety, and efficacy of treatment in this unique population. In a hemodialysis context, identifying patients in need of treatment and preventing HCV transmission may also be a matter of concern. Recently published studies suggest that a combination of paritaprevir/ ritonavir/ombitasvir and dasabuvir, elbasvir/grazoprevir, or glecaprevir/pibrentasvir successfully treats HCV infection in chronic kidney disease stage 4 or 5 patients with or without hemodialysis.
고순영,김병국,김동욱,김정한,최원혁,서희연,권소영 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.4
Reversible focal lesions on the splenium of the corpus callosum (SCC) have been reported in patients with mild encephalitis/encephalopathy caused by various infectious agents, such as influenza, mumps, adenovirus, Varicella zoster, Escherichia coli, Legionella pneumophila, and Staphylococcus aureus. We report a case of a reversible SCC lesion causing reversible encephalopathy in nonfulminant hepatitis A. A 30-year-old healthy male with dysarthria and fever was admitted to our hospital. After admission his mental status became confused, and so we performed electroencephalography (EEG) and magnetic resonance imaging (MRI) of the brain, which revealed an intensified signal on diffusion-weighted imaging (DWI) at the SCC. His mental status improved 5 days after admission, and the SCC lesion had completely disappeared 15 days after admission.
고순영,최원혁 대한의사협회 2014 대한의사협회지 Vol.57 No.1
The goal of antiviral therapy for chronic hepatitis B virus (HBV) infection is to eliminate or suppress HBV with the aim of preventing the devastating complications of cirrhosis, hepatic failure, and hepatocellular carcinoma. Oral antiviral agents suppress but do not eradicate HBV, therefore long-term treatment is necessary to achieve the sustained suppression of viral replication. To optimize the treatment response, treatment should be initiated at an appropriate time with the best available drugs. The indications for treatment are generally based on HBeAg status, serum HBV-DNA level, serum alanine aminotransferase, and the severity of the liver disease. Patients with clinical evidence of active viral replication either with liver inflammation or potentially evolving to cirrhosis should be treated. Nowadays, lamivudine, adefovir, clevudine, telbivudine, entecavir, and tenofovir have been approved for chronic hepatitis B (CHB). Among these, tenofovir and entecavir are potent HBV inhibitors with a high genetic barrier to resistant mutants, so they are recommended by the current treatment guidelines as preferred first-line monotherapies. Failure of antiviral therapy for CHB results in a partial virological response and virological breakthrough, which are related to antiviral-resistant mutants. If genotypic resistance is confirmed, rescue therapy should be initiated, and the regimen should include a potent drug without cross-resistance to prior antiviral agents to minimize the risk of emergence of multiple drug-resistant mutants. This article reviews the current developments in oral antiviral agents, recommendations in CHB treatment guidelines, the medical insurance policy of Korea’s National Health Insurance, and the optimal strategies for using these drugs in clinical practice.