Sezione di Gastroenterologia ed Epatologia, DiBi MIS, University of Palermo, Palermo, Italy.
Liver Int. 2011 Jan;31 Suppl 1:36-44. doi: 10.1111/j.1478-3231.2010.02382.x.
Current guidelines recommend that patients with genotype 2 (G2) and 3 (G3) chronic hepatitis C be treated with pegylated interferon (PEG-IFN) plus low doses of ribavirin (800 mg/day) for 24 weeks, resulting in a sustained virological response (SVR) rate of approximately 80%. Considering these high response rates, several recent randomized trials have assessed whether shorter treatment (12-16 weeks) could be cost-effective in these patients. The results of these studies vary but suggest better responsiveness in G2 patients, and overall, do not strongly support reducing treatment to <24 weeks in all patients. On the other hand, the presence of a rapid virological response (RVR) (defined as an undetectable hepatitis C virus-RNA at 4 weeks of treatment) was always reported to be the best positive predictor of achieving SVR in both G2 and G3 patients. These results suggest that in a subgroup of subjects with RVR (G2>G3, viral load <400,000 IU, low fibrosis, no metabolic cofactors), shorter treatment is as effective as standard regimens, and that it can be proposed mainly if problems of poor tolerance or adherence are foreseen. It is possible that the SVR rate in non-RVR patients and non-responder patients could also be improved by prolonging therapy, but this must be specifically investigated in other studies along with the role of IL28B polymorphisms.
目前的指南建议基因型 2（G2）和 3（G3）慢性丙型肝炎患者采用聚乙二醇干扰素（PEG-IFN）加低剂量利巴韦林（800mg/天）治疗 24 周，持续病毒学应答（SVR）率约为 80%。考虑到这些高应答率，最近有几项随机试验评估了在这些患者中缩短治疗时间（12-16 周）是否具有成本效益。这些研究的结果各不相同，但表明 G2 患者的反应性更好，总体上并不强烈支持所有患者将治疗时间缩短至<24 周。另一方面，快速病毒学应答（RVR）（定义为治疗 4 周时无法检测到丙型肝炎病毒 RNA）的存在始终被报道为 G2 和 G3 患者实现 SVR 的最佳阳性预测指标。这些结果表明，在 RVR（G2>G3、病毒载量<40 万 IU、低纤维化、无代谢合并症）亚组患者中，缩短治疗与标准方案同样有效，如果预计存在耐受性或依从性问题，可以主要推荐这种方案。延长治疗时间可能也会提高非 RVR 患者和无应答患者的 SVR 率，但这必须在其他研究中与 IL28B 多态性的作用一起进行专门研究。
