Management of hepatitis C virus infection: the basics.
Management of hepatitis C virus infection: the basics.
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作者：
S. Naggie
慢性丙型肝炎病毒（HCV）感染影响全世界约1.7亿人，其中包括美国的300万至400万人，他们基本上不知道自己的感染状况。HCV有6种基因型;基因型1在美国是最常见的，基因型1和4比其它基因型对基于α-干扰素的治疗的反应性低。用现有的直接作用抗病毒（DAA）药物治疗增加了基因型1感染的持续病毒学应答（SVR）率，并缩短了许多患者的治疗持续时间，但此时这些药物仍必须与聚乙二醇干扰素α和利巴韦林一起使用，以防止快速出现耐药性。治疗应答的基线预测因子继续在三联疗法中发挥作用，包括药物遗传学IL 28 B基因型，其在世界各地的流行率不同。三联药物联合治疗的停止/无效规则不同，允许更早做出决策。最终，SVR是HCV治疗的目标，因为它大大降低了长期预后不良的可能性，即使在组织学晚期疾病患者中也是如此。本文总结了Susanna Naggie，MD，在2012年10月在亚特兰大举行的IAS-USA HCV继续医学教育项目现场管理中提出的基本评论。这篇文章的目的是为从业者谁是新的HCV管理或谁有兴趣审查HCV治疗的基础知识。
Chronic hepatitis C virus (HCV) infection affects some 170 million people worldwide, including 3 to 4 million in the United States who are largely unaware of their infection status. HCV has 6 genotypes; genotype 1 is the most common in the United States and genotypes 1 and 4 are less responsive to interferon alfa-based therapy than the other genotypes. Treatment with available direct-acting antiviral (DAA) drugs has increased sustained virologic response (SVR) rates in genotype 1 infection and shortened duration of therapy in many patients, but at this time these agents must still be administered with peginterferon alfa and ribavirin to prevent rapid emergence of resistance. Baseline predictors of response to therapy continue to play a role with triple-drug combination therapy including the pharmacogenetic IL28B genotype, which differs in prevalence throughout the world. The stopping/futility rules are different for triple-drug combination therapy, allowing for earlier decision-making. Ultimately, SVR is the goal of HCV treatment because it dramatically reduces likelihood of poor long-term outcome, even among patients with histologically advanced disease. This article summarizes a basic review presented by Susanna Naggie, MD, at the IAS-USA live management of HCV continuing medical education program held in Atlanta in October 2012. This article is intended for practitioners who are new to HCV management or who are interested in reviewing the basics of HCV treatments.