Vince Adriana, Duvnjak Marko
Dr. Fran Mihaljević University Hospital, Zagreb, Croatia.
Acta Med Croatica. 2009 Dec;63(5):409-15.
According to published data, 60% of hepatitis C virus (HCV)-infected patients in Croatia have HCV genotype 1. The second most common genotype is 3a (36%). Standard treatment regimen for patients with chronic hepatitis C is a combination of pegylated interferon alfa (2a or 2b) with ribavirin, in duration guided by genotype: patients with genotype 1 are treated for 48 weeks and patients with genotypes 2 and 3 for 24 weeks in order to achieve virus elimination defined as HCV RNA undetectability 24 weeks after the treatment period (SVR). These treatment regimens fail to achieve SVR in 50% of patients with genotype 1 and 25% of patients with genotype 3. On the other hand, patients with low viral load (<600 000 IU HCV RNA/mL) and rapid viral response (RVR) could benefit from shortened treatment. Recent studies and meta-analyses have shown the importance of liver fibrosis, viral kinetics and viremia as predictors of SVR. Currently, treatment of chronic hepatitis C should be individualized (treatment guided) according to the genotype, liver fibrosis, early viral kinetics and viremia. In patients with genotype 1 who are late responders (pEVR), therapy should be prolonged to 72 weeks in order to achieve 12% better SVR. In patients with genotype 2,3 with low viremia who are rapid responders (RVR+), therapy can be shortened to 16 weeks. Patients with higher fibrosis rates (presence of fibrotic septa) should not be treated according to the level of viremia, as it has been shown that viremia does not correlate with SVR in these patients. Liver biopsy is still recommended in the pretreatment evaluation protocol for its prognostic features. In patients with acute hepatitis C, treatment should be started if HCV RNA is still present at week 12. The suggested treatment regimen is monotherapy with pegylated interferon alfa (2a or 2b) for 24 weeks.
根据已发表的数据，克罗地亚60%的丙型肝炎病毒（HCV）感染患者为HCV基因1型。第二常见的基因型是3a型（36%）。慢性丙型肝炎患者的标准治疗方案是聚乙二醇化干扰素α（2a或2b）与利巴韦林联合使用，疗程根据基因型而定：基因1型患者治疗48周，基因2型和3型患者治疗24周，以实现病毒清除，定义为治疗期结束后24周检测不到HCV RNA（持续病毒学应答，SVR）。这些治疗方案在50%的基因1型患者和25%的基因3型患者中未能实现SVR。另一方面，病毒载量低（<600 000 IU HCV RNA/mL）且快速病毒学应答（RVR）的患者可能从缩短疗程中获益。最近的研究和荟萃分析表明，肝纤维化、病毒动力学和病毒血症作为SVR预测指标的重要性。目前，慢性丙型肝炎的治疗应根据基因型、肝纤维化、早期病毒动力学和病毒血症进行个体化（治疗指导）。基因1型的迟发型应答者（pEVR），治疗应延长至72周，以提高12%的SVR。基因2、3型且病毒血症低的快速应答者（RVR+），治疗可缩短至16周。纤维化率较高（存在纤维间隔）的患者不应根据病毒血症水平进行治疗，因为已表明这些患者的病毒血症与SVR无关。肝活检因其预后特征仍被推荐用于预处理评估方案。急性丙型肝炎患者，如果第12周时仍存在HCV RNA，应开始治疗。建议的治疗方案是聚乙二醇化干扰素α（2a或2b）单药治疗24周。
