Nguyen-Khac Eric, Capron Dominique, Castelain Sandrine, François Catherine, Braillon Alain
Service d'Hépato-Gastroentérologie et Réseau Hépatite C-Picardie Centre Hospitalier Universitaire d'Amiens Place Victor Pauchet, F-80054 Amiens cedex 01, France.
Eur J Intern Med. 2007 Nov;18(7):510-5. doi: 10.1016/j.ejim.2007.02.010. Epub 2007 Jul 9.
Pegylated interferon plus ribavirin is the standard treatment for chronic hepatitis C (CHC). It yields sustained virological response (SVR) rates of 42-52% for genotype 1, 66-72% for genotype 4, and 76-80% for genotypes 2 and 3. Hence, the patient's genotype appears to be a determining predictive factor for the SVR. We have reviewed the literature in order to determine whether a genotype-specific treatment duration should be envisaged. The largest study to date of patients infected with HCV genotype 2 or 3 confirmed the value of the standard treatment duration of 24 weeks. Shorter treatments exposed the patients to a greater risk of relapse. For genotype 1, it was possible to offer a shorter, 24-week course of treatment to the 35% of patients with an initial viral load below 600,000 IU/mL and an early virological response (EVR) at week 4 (negative PCR), resulting in an SVR of 89%. For the remaining two-thirds of genotype 1 patients with a high viral load, the treatment duration should remain at 48 weeks. A subgroup of patients - the "slow virological responders" (positive PCR at week 12 but with less than 6000 IU/mL; negative PCR at week 24) - benefited from the extension of the treatment to 72 weeks, with an SVR of 88%. For patients infected with genotype 4 virus, combination therapy should feature a ribavirin dose of more than 1000 mg/day for an optimal duration of 48 weeks.
聚乙二醇干扰素联合利巴韦林是慢性丙型肝炎（CHC）的标准治疗方案。对于1型基因型，其持续病毒学应答（SVR）率为42%-52%；对于4型基因型，SVR率为66%-72%；对于2型和3型基因型，SVR率为76%-80%。因此，患者的基因型似乎是SVR的决定性预测因素。我们回顾了相关文献，以确定是否应考虑针对特定基因型设定治疗疗程。迄今为止，关于感染丙型肝炎病毒2型或3型患者的最大规模研究证实了24周标准治疗疗程的价值。较短疗程的治疗会使患者面临更高的复发风险。对于1型基因型，对于初始病毒载量低于600,000 IU/mL且在第4周出现早期病毒学应答（EVR，PCR阴性）的35%患者，可以提供为期24周的较短疗程治疗，其SVR率为89%。对于其余三分之二病毒载量高的1型基因型患者，治疗疗程应保持在48周。有一组患者——“病毒学应答缓慢者”（第12周PCR阳性但低于6,000 IU/mL；第24周PCR阴性）——将治疗延长至72周可从中获益，其SVR率为88%。对于感染4型病毒的患者，联合治疗的利巴韦林剂量应超过每日1000 mg，最佳疗程为48周。
