Depression and antiviral response to interferon-based therapy for hepatitis C virus infection.
Depression and antiviral response to interferon-based therapy for hepatitis C virus infection.
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丙型肝炎病毒感染的干扰素治疗的抑郁症和抗病毒反应。
DOI：
10.1002/hep.24064
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Hauser,Peter
中科院分区：
文献类型：
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作者：
Loftis,JenniferM;Morasco,BenjaminJ;Hauser,Peter
我们非常感兴趣地阅读了Stepanova等人的文章。1在这份来自美国的报告中，10582名符合条件的个体（其中1.52%的人丙型肝炎病毒抗体[抗-HCV]阳性），HCV感染患者的保险覆盖率（61.2%）明显低于未感染HCV的受试者（81.2%），特别是66.7%的患者可以接受治疗（54.3%）。只有36.3%的hcv感染患者可能有资格接受治疗并有健康保险。作者认为，HCV感染患者获得护理至关重要，其结果可能对HCV感染患者的健康保险覆盖范围具有重要意义，应在新的医疗改革立法中予以考虑。在目前的标准治疗（SOC）方案中，聚乙二醇化干扰素- α (PegIFN)和利巴韦林联合治疗，在西方国家，基因型1和2/3患者的持续病毒学应答（SVR）率分别约为50%和83%。2,3除了PegIFN/利巴韦林众所周知的不良反应（可能使医生和患者都感到害怕，需要仔细监测和管理）之外，阻止患者接受SOC的另一个重要障碍是HCV治疗的高成本，作者估计在美国每年高达48,000美元。考虑到大多数患者无法负担治疗费用，减少经济影响的保险覆盖对这些患者至关重要。最近，Yan等人也报道，在香港，在政府报销所有慢性丙型肝炎（CHC）治疗之前，对费用的担忧是不接受治疗的最常见原因之一（37%）。4减轻丙型肝炎治疗的经济负担有助于提高CHC患者的治疗接受度。在台湾，基因1型和2型感染的CHC患者接受PegIFN/利巴韦林治疗，在我们之前的随机试验中获得了很高的SVR率（分别为80%和95%）。5,6此外，亚洲患者在白素- 28b基因中具有最高频率的优势等位基因，在我们的报告中，高达88%的台湾CHC患者具有rs8099917 TT基因型，7,8已被证明是应答的重要预测因子。鼓励台湾CHC患者接受SOC方案似乎是合理的。(2)丙氨酸转氨酶水平！2Â 6个月内两次正常上限间隔3个月；(3)纤维化期！2（自2004年起修订为第1阶段或更高阶段）。2009年进一步修订了诊断标准：(1)抗-HCV阳性和血清HCV RNA阳性；(2)丙氨酸转氨酶水平异常。因此，更多的台湾CHC患者可能会在允许的报销要求下接受治疗。我们在台湾构建了“路线图”概念，确定了治疗时间10，并采用截断治疗策略，对于基因型为1/4和基因型为2/3的HCV患者，估计每SVR的药物成本节约分别达到11.8%和29%。我们可以做出更多的努力来帮助病人。例如，台湾的全民健康保险计划得到了一致好评，但尚未报销使用造血药物的费用……
We read with great interest the article by Stepanova et al. 1 In this report from the United States with 10,582 eligible individuals (1.52% of whom were positive for hepatitis C virus [HCV] antibody [anti-HCV]), the rate of insurance coverage was significantly lower in patients with HCV infection (61.2%), particularly in 66.7% patients who could be candidates for treatment (54.3%), than in subjects without HCV infection (81.2%). Only 36.3% of HCV-infected patients were potentially eligible for treatment and had health insurance. The authors considered that access to care for patients infected with HCV is critical, and their results can have important implications for health insurance coverage of HCV-infected patients and should be considered under the new health care reform legislation.With the current standard-of-care (SOC) regimen with a combination of pegylated interferon-alfa (PegIFN) and ribavirin, sustained virological response (SVR) rates in Western countries were around 50% and 83% for genotype 1 and 2/3 patients, respectively. 2, 3 In addition to the well-known adverse effects of the PegIFN/ribavirin, which might terrify both physicians and patients and need careful monitoring as well as management, another important barrier that prevents patients from receiving SOC is the high cost of treatment of HCV, which the authors estimate is up to $48,000 per year in the United States. Insurance coverage to reduce the economic impact is critical in these patients, given the inability of most to afford the treatment. Recently, Yan et al. also reported that concern about cost is one of the most common causes (37%) for nontreatment before the government reimbursed all treatment for chronic hepatitis C (CHC) in Hong Kong. 4 Reduction of the economic burden for HCV therapy helps improve the treatment uptake of patients with CHC. In Taiwan, patients with CHC who are infected with genotype 1 and 2, and who are treated with PegIFN/ribavirin, achieve high SVR rates in our previous randomized trials (80% and 95%, respectively). 5, 6 In addition, Asian patients had the highest frequency of the advantageous allele in the gene for interleukin-28B, with up to 88% of Taiwanese patients with CHC having the rs8099917 TT genotype in our reports, 7, 8 which has been shown to be an important predictor of response. It seems reasonable to encourage Taiwanese patients with CHC to undertake the SOC regimen. In Taiwan, National Health Insurance (NHI) commenced in 1995, with a very high universal coverage rate of 99.5% by the end of 2008, resulting in a narrowed disparity in health care between the wealthy and the poor. 9 The reimbursement for anti-HCV therapy by the Taiwanese NHI started in 2003 if patients meet all the criteria:(1) positive for anti-HCV;(2) the alanine aminotransferase levels! 2Â upper limit of normal on two occasions 3 months apart during the 6-month period; and (3) fibrosis stage! 2 (revised to stage 1 or greater since 2004). The criteria were further revised in 2009:(1) patients with positive anti-HCV and serum HCV RNA and (2) abnormal alanine aminotransferase levels. Accordingly, more Taiwanese patients with CHC can be expected to receive therapy under this permitted reimbursement claim. We have constructed the ‘‘roadmap’’concept with the determined duration of therapy in Taiwan10 and using the strategy to truncate treatment, the estimated cost saving of drugs achieves 11.8% and 29% per SVR for HCV genotype 1/4 and genotype 2/3 patients, respectively. We can make more efforts to help patients. For instance, the NHI program in Taiwan, which is given unanimous praise, does not yet reimburse the use of hematopoietic agents …