Zeuzem S, Berg T, Moeller B, Hinrichsen H, Mauss S, Wedemeyer H, Sarrazin C, Hueppe D, Zehnter E, Manns M P
Zentrum der Inneren Medizin, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
J Viral Hepat. 2009 Feb;16(2):75-90. doi: 10.1111/j.1365-2893.2008.01012.x. Epub 2008 Aug 28.
The current preferred treatment for patients with hepatitis C virus (HCV) is combination therapy consisting of pegylated interferon alfa and ribavirin (RBV) for 24-48 weeks. Although this approach appears to be highly effective for patients with HCV genotypes 2 or 3, who have a sustained virological response (SVR) of approximately 80%, the treatment algorithm is less effective for patients with HCV genotype 1, as these patients have SVR rates of just 40-50%. In order to improve treatment outcomes, this article explores potential approaches for the optimization of treatment for patients with HCV genotype 1: considering shorter treatment periods for patients with a rapid virological response (RVR), increasing treatment periods for slow responders, and increasing RBV dose are all suggestions. Results from clinical trials suggest that approximately 20% of the HCV genotype 1-infected population are slow responders, and around 15% of all HCV genotype-1 infected patients could benefit from a shorter treatment duration without compromising the SVR rate. Interest has also focused on whether treatment duration could be individualized in some patients with genotype 2 and 3 infection. Here all the findings from recent studies are translated into practical advice, to help practitioners make evidence-based treatment decisions in everyday clinical practice. Although there are areas where currently available data do not provide conclusive evidence to suggest amending treatment approaches, there is clearly potential for individualized treatment in all aspects of hepatitis treatment in the future.
目前，丙型肝炎病毒（HCV）患者的首选治疗方法是聚乙二醇化干扰素α与利巴韦林（RBV）联合治疗，疗程为24至48周。尽管这种方法对HCV基因2型或3型患者似乎非常有效，其持续病毒学应答（SVR）率约为80%，但对于HCV基因1型患者，该治疗方案的效果较差，因为这些患者的SVR率仅为40%至50%。为了改善治疗效果，本文探讨了优化HCV基因1型患者治疗的潜在方法：对于病毒学应答快速（RVR）的患者考虑缩短治疗期、对于应答缓慢的患者延长治疗期以及增加RBV剂量等都是建议。临床试验结果表明，约20%的HCV基因1型感染人群应答缓慢，并且在不影响SVR率的情况下，约15%的所有HCV基因1型感染患者可能受益于较短的治疗疗程。人们还关注对于某些基因2型和3型感染患者，治疗疗程是否可以个体化。在此，将近期研究的所有结果转化为实用建议，以帮助从业者在日常临床实践中做出基于证据的治疗决策。尽管在某些领域，现有数据并未提供确凿证据表明需要修改治疗方法，但未来在丙型肝炎治疗的各个方面显然都有个体化治疗的潜力。
