Escuret Vanessa, Zoulim Fabien
Inserm U271, 151, cours Albert Thomas, 69424 Lyon Cedex 03
Rev Prat. 2005 Mar 31;55(6):633-45.
Hepatitis C virus (HCV) infects approximately 3 % of the global population and represents a major public health problem worldwide. Treatment of chronic hepatitis C is based on the combination of pegylated interferon alpha (PEG IFN) with ribavirin. With this treatment, sustained virological response is obtained in around 80% of patients infected with HCV genotype 2 or 3 and 50% of patients infected with HCV genotype 1. The most frequent adverse events are the flu-like syndrome and psychiatric disorders for PEG IFN, and anaemia for ribavirin; they need a careful follow-up. Determination of viral load and genotype is essential for the indication of therapy and the follow-up during treatment. Patients infected with HCV genotype 2 or 3 should be treated for 24 weeks. In patients infected with HCV genotype 1, a decrease in viral load by 2 log after 12 weeks of treatment (early virological response) is needed to take the decision to continue treatment, for a total duration of 48 weeks. A poor response to treatment is associated with host factors (age, alcohol consumption, cirrhosis) and viral factors (genotype 1, high viral load, co-infection with HBV or HIV). New therapeutic approaches should be based on the combination of PEG IFN and specific inhibitors of HCV replication to increase the rate of sustained response.
丙型肝炎病毒（HCV）感染了全球约3%的人口，是全球主要的公共卫生问题。慢性丙型肝炎的治疗基于聚乙二醇化干扰素α（PEG IFN）与利巴韦林联合使用。采用这种治疗方法，感染HCV 2型或3型的患者中约80%可获得持续病毒学应答，感染HCV 1型的患者中50%可获得持续病毒学应答。最常见的不良事件是PEG IFN引起的流感样综合征和精神障碍，以及利巴韦林引起的贫血；这些都需要密切随访。病毒载量和基因型的测定对于治疗指征及治疗期间的随访至关重要。感染HCV 2型或3型的患者应接受24周的治疗。对于感染HCV 1型的患者，治疗12周后病毒载量下降2个对数（早期病毒学应答）是决定是否继续治疗的必要条件，总疗程为48周。治疗反应不佳与宿主因素（年龄、饮酒、肝硬化）和病毒因素（1型基因型、高病毒载量、合并HBV或HIV感染）有关。新的治疗方法应基于PEG IFN与HCV复制特异性抑制剂联合使用，以提高持续应答率。
