Viral Hepatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nat Rev Gastroenterol Hepatol. 2011 Apr;8(4):212-23. doi: 10.1038/nrgastro.2011.21. Epub 2011 Mar 8.
HCV infects approximately 2-3% of the global population and is a leading cause of end-stage liver disease and hepatocellular carcinoma. Treatment of HCV infection with Peg-IFN in combination with ribavirin can eradicate HCV infection in 40-90% of patients; however, a major barrier to treatment uptake and delivery is the association of this therapy with frequent and, at times, serious adverse effects. Recognition and effective management of these adverse effects are critical components of the successful treatment of chronic HCV infection. In clinical trials, approximately 10-15% of patients discontinue Peg-IFN and ribavirin therapy due to adverse effects; however, in clinical practice, the rate of treatment discontinuation has been reported to be substantially higher. The off-target effect of Peg-IFN and ribavirin impacts most, if not all, organ systems; the most common adverse effects are hematologic, dermatologic, neurologic, immunologic, gastrointestinal, pulmonary, cardiovascular, and ocular. Regional and global variability exists in the nature of these adverse effects and the strategies employed to ameliorate their impact. This article provides a comprehensive literature review that systematically describes the adverse effects of Peg-IFN-α and ribavirin on various organ systems and, more importantly, recommends consensus approaches to managing those effects.
HCV 感染全球人口的 2-3%，是导致终末期肝病和肝细胞癌的主要原因。聚乙二醇干扰素（Peg-IFN）联合利巴韦林治疗 HCV 感染，可使 40-90%的患者清除 HCV 感染；然而，治疗接受率和实施率的主要障碍是该疗法与频繁且有时严重的不良反应相关。识别和有效管理这些不良反应是成功治疗慢性 HCV 感染的关键组成部分。在临床试验中，约有 10-15%的患者因不良反应而停止 Peg-IFN 和利巴韦林治疗；然而，在临床实践中，报道的治疗中止率要高得多。Peg-IFN 和利巴韦林的非靶向作用影响大多数（如果不是全部）器官系统；最常见的不良反应是血液学、皮肤、神经、免疫、胃肠道、肺、心血管和眼部不良反应。这些不良反应的性质以及减轻其影响所采用的策略在区域和全球范围内存在差异。本文提供了一份全面的文献综述，系统地描述了 Peg-IFN-α和利巴韦林对各种器官系统的不良反应，并更重要的是，推荐了管理这些不良反应的共识方法。
