Poordad Fred, Reddy K Rajender, Martin Paul
Hepatology and Liver Transplantation, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Clin Infect Dis. 2008 Jan 1;46(1):78-84. doi: 10.1086/523585.
Rapid virologic response (RVR), defined as an undetectable serum hepatitis C virus (HCV) RNA level at week 4 of treatment, is emerging as an important milestone in the treatment of patients who have chronic hepatitis C by use of pegylated interferon-alfa and ribavirin--the current standard of care. This assessment is being used to individualize treatment duration, which is currently recommended as 48 weeks in patients infected with HCV genotype 1 (G1) and 24 weeks in those infected with HCV G2 or G3.
We collated information from studies including assessment of HCV RNA level at week 4, specifically highlighting the relationship between RVR and other predictors of treatment outcome and the manner in which RVR can be used to optimize treatment outcomes for specific patient groups.
The role of RVR in the treatment of patients with chronic hepatitis C varies according to viral genotype. Among patients with HCV G2/G3 infection, several studies have shown that shortening the treatment duration to 12-16 weeks is effective among those who attain RVR. In contrast, RVR may be used as an indicator for both shortened and extended treatment durations among patients with HCV G1 infection. HCV G1-infected patients with low baseline viral load who attain RVR may be effectively treated for 24 weeks, whereas patients who do not attain RVR may be candidates for an extended 72-week regimen.
RVR is rapidly becoming a new tool for predicting treatment outcomes in patients with chronic hepatitis C and represents a key opportunity to individualize therapy according to treatment-related viral kinetics.
快速病毒学应答（RVR）定义为治疗第4周时血清丙型肝炎病毒（HCV）RNA水平检测不到，它正成为使用聚乙二醇化干扰素-α和利巴韦林治疗慢性丙型肝炎患者（当前的标准治疗方法）过程中的一个重要里程碑。这一评估正被用于个体化治疗疗程，目前推荐HCV基因1型（G1）感染者的治疗疗程为48周，HCV G2或G3感染者为24周。
我们整理了各项研究的信息，包括对第4周时HCV RNA水平的评估，特别强调了RVR与其他治疗结果预测指标之间的关系，以及RVR可用于优化特定患者群体治疗结果的方式。
RVR在慢性丙型肝炎患者治疗中的作用因病毒基因型而异。在HCV G2/G3感染患者中，多项研究表明，对于实现RVR的患者，将治疗疗程缩短至12 - 16周是有效的。相比之下，RVR可作为HCV G1感染患者缩短和延长治疗疗程的指标。基线病毒载量低且实现RVR的HCV G1感染患者可能接受24周的有效治疗，而未实现RVR的患者可能适合延长至72周的治疗方案。
RVR正迅速成为预测慢性丙型肝炎患者治疗结果的新工具，并代表了根据治疗相关病毒动力学进行个体化治疗的关键机会。
