Prevalence and Treatment of Chronic Hepatitis C Virus Infection in the US Department of Veterans Affairs
Prevalence and Treatment of Chronic Hepatitis C Virus Infection in the US Department of Veterans Affairs
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DOI：
10.1093/epirev/mxu002
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发表时间：
2015-01-01
影响因子：
5.5
通讯作者：
Ioannou, George N.
中科院分区：
文献类型：
--
作者：
Beste, Lauren A.;Ioannou, George N.
慢性丙型肝炎病毒（HCV）是美国最常见的血液传播病原体。HCV不成比例地影响退伍军人事务部（VA）卫生保健用户：2013年有174，302名HCV感染的退伍军人接受VA护理，使VA成为世界上最大的HCV护理提供者。这项系统性综述在VA中识别了546篇与HCV相关的文章。经过2名独立评审员的评估，28篇描述VA使用者中HCV患病率和治疗的文章最终符合纳入标准。大多数患有HCV感染的VA患者出生于1945年至1965年之间，并在1970年至1990年之间感染HCV。为了预防HCV相关的并发症，如肝硬化、肝细胞癌和死亡，医务人员必须识别和治疗HCV。然而，抗病毒治疗历来受到药物副作用、禁忌症和患者接受度的限制。虽然VA的治疗开始率高于美国，但只有23%的VA HCV患者接受了治疗，其中只有少数人治愈。最近开发的更有效和耐受的抗病毒药物是一个重大的药理学突破。理论上，大多数HCV患者首次根除HCV是可能的，尽管新的障碍，如高昂的药物成本，可能会限制未来的吸收。
Chronic hepatitis C virus (HCV) is the most common blood-borne pathogen in the United States. HCV disproportionately affects Veterans Affairs (VA) health-care users: 174,302 HCV-infected veterans were in VA care in 2013, making the VA the world's largest HCV care provider. This systematic review identified 546 articles related to HCV in the VA. After assessment by 2 independent reviewers, 28 articles describing prevalence and treatment of HCV in VA users ultimately met inclusion criteria. Most VA patients currently living with HCV infection were born between 1945 and 1965 and were infected with HCV between 1970 and 1990. To prevent HCV-related complications such as cirrhosis, hepatocellular carcinoma, and death, medical personnel must identify and treat HCV. However, antiviral therapy has historically been limited by medication side effects, contraindications, and patient acceptance. Although treatment initiation rates are higher in the VA than in the general United States, only 23% of VA HCV patients have received treatment and, of those, only a minority were cured. Recent development of more effective and tolerable antiviral agents represents a major pharmacological breakthrough. Eradication of HCV is theoretically possible for the majority of HCV patients for the first time, although new barriers, such as high drug costs, may limit future uptake.