McHutchison John G, Bacon Bruce R
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Am J Manag Care. 2005 Oct;11(10 Suppl):S286-95; quiz S307-11.
There are at least 2.7 million individuals in the United States, most of them in their 40s and 50s, who are chronically infected with hepatitis C virus (HCV). As these infected individuals get older, about 20% will develop cirrhosis, and a significant fraction of those with cirrhosis (about 1 in 10) will then develop serious decompensated liver disease or hepatocellular carcinoma. Currently, HCV is the primary cause of death in 8000 to 12 000 people every year; the virus is also the primary reason for liver transplantation in the United States. Although the number of new cases of HCV infection has been dropping steadily since the introduction of improved blood-supply screening, the "age wave" of existing chronic HCV in baby boomers is expected to contribute to a substantial rise in morbidity, mortality, and costs over the next 2 decades. Although it is difficult to predict which HCV-infected patients will progress to serious liver disease, the availability of a combination drug regimen (peginterferon alfa plus ribavirin) that essentially "cures" the disease in more than half of treated patients now provides clinicians and pharmacists in managed care settings with the tools needed to diminish the impact of the anticipated wave of liver disease. This article reviews the epidemiology, natural history, clinical and economic burden, and screening and treatment options for HCV.
美国至少有270万人长期感染丙型肝炎病毒（HCV），其中大多数人年龄在四五十岁。随着这些感染者年龄的增长，约20%的人会发展为肝硬化，而肝硬化患者中有很大一部分（约十分之一）会进而发展为严重的失代偿性肝病或肝细胞癌。目前，HCV是每年8000至12000人死亡的主要原因；该病毒也是美国肝脏移植的主要原因。尽管自改进血液供应筛查以来，HCV感染的新病例数量一直在稳步下降，但婴儿潮一代中现有的慢性HCV“年龄浪潮”预计将在未来20年导致发病率、死亡率和成本大幅上升。虽然很难预测哪些HCV感染患者会发展为严重肝病，但一种联合药物疗法（聚乙二醇干扰素α加利巴韦林）能在一半以上的治疗患者中基本“治愈”该病，这为管理式医疗环境中的临床医生和药剂师提供了减轻预期肝病浪潮影响所需的工具。本文综述了HCV的流行病学、自然史、临床和经济负担以及筛查和治疗选择。
