Treatment of hepatitis C in special populations.
Treatment of hepatitis C in special populations.
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DOI：
10.1007/s00535-017-1427-x
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发表时间：
2018-05
影响因子：
6.3
通讯作者：
Sakamoto N
中科院分区：
文献类型：
--
作者：
Suda G;Ogawa K;Morikawa K;Sakamoto N
丙型肝炎病毒（HCV）感染是导致肝硬化和肝癌的主要原因之一。在血液透析患者中，HCV感染率很高，而且与预后不良有关。在HCV感染的肝移植患者中，复发的HCV感染是普遍的，并且再感染的HCV导致肝纤维化和移植物损失的快速进展。此外，在HCV和人类免疫缺陷病毒（HIV）合并感染的患者中，肝纤维化进展迅速。因此，迫切需要在这些特殊人群（即，血液透析、肝移植、HIV合并感染）。然而，直到最近，标准的抗HCV治疗涉及使用基于干扰素的治疗。在这些特殊人群中，基于干扰素的治疗不能达到高的持续病毒应答率，而且与更高的不良事件发生率相关。随着新型直接作用抗病毒药物（DAA）的开发，特殊人群的抗HCV治疗前景发生了巨大变化。事实上，在接受无干扰素DAA治疗的特殊人群中，持续病毒应答率超过90%，不良事件的发生率和严重程度较低。
Hepatitis C virus (HCV) infection is one of the primary causes of liver cirrhosis and hepatocellular carcinoma. In hemodialysis patients, the rate of HCV infection is high and is moreover associated with a poor prognosis. In liver transplantation patients with HCV infection, recurrent HCV infection is universal, and re-infected HCV causes rapid progression of liver fibrosis and graft loss. Additionally, in patients with HCV and human immunodeficiency virus (HIV) co-infection, liver fibrosis progresses rapidly. Thus, there is an acute need for prompt treatment of HCV infection in these special populations (i.e., hemodialysis, liver transplantation, HIV co-infection). However, until recently, the standard anti-HCV treatment involved the use of interferon-based therapy. In these special populations, interferon-based therapies could not achieve a high rate of sustained viral response and moreover were associated with a higher rate of adverse events. With the development of novel direct-acting antivirals (DAAs), the landscape of anti-HCV therapy for special populations has changed dramatically. Indeed, in special populations treated with interferon-free DAAs, the sustained viral response rate was above 90%, with a lower incidence and severity of adverse events.
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