Brown Robert S
Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, 622 West 168th Street, PH 14, New York, NY 10032, USA.
Nat Clin Pract Gastroenterol Hepatol. 2007 Jan;4 Suppl 1:S3-9. doi: 10.1038/ncpgasthep0693.
Combination treatment with pegylated interferon plus ribavirin is the most effective therapy for patients with chronic hepatitis C virus (HCV); however, responses are less than optimal in some subpopulations of patients. Emerging insights are suggesting that viral kinetics can be used to predict response. The rapidity of response has been shown to be a more important predictor of sustained virologic response than the duration of therapy. In patients with HCV genotype 2 or 3, shorter durations of treatment might be sufficient in rapid responders and could minimize the risk of toxic effects. Weight-based dosing of ribavirin has emerged as another important consideration. This strategy seems to be most important for difficult-to-treat patients with HCV genotype 1 or advanced fibrosis, and for African-Americans, and is possibly important for patients who have genotype 3 and a high viral load. Re-treatment of nonresponders with interferon-based therapy has been associated with low rates of sustained virologic response. Consensus interferon might offer a new option for patients who do not achieve an early treatment response to standard or pegylated interferon plus ribavirin.
聚乙二醇化干扰素联合利巴韦林治疗是慢性丙型肝炎病毒（HCV）患者最有效的治疗方法；然而，在某些亚组患者中，治疗反应并不理想。新出现的见解表明，病毒动力学可用于预测治疗反应。已证明反应速度比治疗持续时间更能预测持续病毒学反应。对于HCV基因2型或3型患者，快速反应者较短的治疗时间可能就足够了，并且可以将毒性作用风险降至最低。基于体重的利巴韦林给药已成为另一个重要考虑因素。该策略似乎对HCV基因1型或晚期纤维化的难治性患者以及非裔美国人最为重要，对基因3型且病毒载量高的患者可能也很重要。基于干扰素的疗法对无反应者进行再治疗与持续病毒学反应率较低有关。对于对标准或聚乙二醇化干扰素加利巴韦林未获得早期治疗反应的患者，共识干扰素可能提供一种新的选择。
