The in vitro culture of hepatitis C virus and approaches to the control of replication

丙型肝炎病毒是肝病的主要原因，目前全球约有2亿人感染，其中包括20万澳大利亚人。丙型肝炎病毒与其他黄病毒不同。最值得注意的是，大约80%的人会发展为持续性感染，这是大量携带者的原因。这种感染可能是终生的，40%-50%的携带者会发展成严重的肝病，包括肝癌。目前，丙型肝炎病毒是西方世界领先的肝移植单一指标。这些携带者还可以将病毒传播给未感染的人。血库的筛查已经将输血后的传播率降至几乎为零。然而，尽管共用受污染针头的个人是主要的高危人群，但约30%的携带者没有公认的传播风险因素，并且已认识到在医院将病毒传播给患者。因此，很明显，普通人群中的成员仍然可能受到感染。据估计，澳大利亚每年有1万例新病例。最好的治疗方法是干扰素-α和利巴韦林的组合，但这只在40%-50%的携带者中有效。此外，许多患者无法耐受这些药物，而且成本限制了治疗仅限于一小部分携带者。因此，澳大利亚只有大约6500名携带者接受了治疗。肝脏诊所的大量积压以及澳大利亚50%的患者对病毒的抗药性意味着，除非开发新的治疗方法，否则这些患者将不会得到治疗。预防病毒感染最有效的方法是接种疫苗。因此，开发新型抗病毒药物和丙型肝炎疫苗是当务之急。由于一次肝脏移植的费用是10万美元，开发这种药物很可能是划算的。然而，有必要开发合适的细胞培养系统来测试可能的抗病毒药物。

HCV is a major cause of liver disease and around 200 million people are currently infected worldwide, including 200,000 Australians. HCV differs to other flaviviruses. Most notably, around 80% of individuals develop a persistent infection, accounting for the large number of carriers. This infection is probably life-long and 40-50% of carriers will develop serious liver disease, including liver cancer. HCV is currently the leading single indicator for liver transplantation in the western world. These carriers can also transmit the virus to uninfected individuals. Screening in the blood banks has reduced transmission after blood transfusion to virtually zero. However, although individuals who share contaminated needles represent a major high risk population, around 30% of carriers have no acknowledged transmission risk factors, and transmission to patients in hospitals has been recognised. As a result, it is clear that members of the general population may still become infected. It has been estimated that there are 10,000 new cases each year in Australia. The best available treatment is a combination of interferon-alpha and ribavirin, but this is only successful in 40-50% of carriers. Moreover, many patients fail to tolerate these drugs and the cost restricts treatment to a small proportion of carriers. As a result,only approx 6,500 carriers have been treated in Australia. A huge backlog in the liver clinics and the resistant nature of the virus in 50% of patients in Australia mean that these patients will not be treated unless new therapies are developed. The most effective means to prevent virus infections is by vaccination. Thus the development of novel antivirals and a vaccine for HCV are priorities. Since the cost of a single liver transplant is $100,000 the development of such agents is likely to be cost effective. However, it is necessary to develop suitable cell culture systems to test putative antiviral agents.