Internal Medicine and Hepatology Division, Second University of Naples, Italy.
Expert Rev Anti Infect Ther. 2011 May;9(5):535-43. doi: 10.1586/eri.11.10.
HCV infection is a very common cause of chronic viral hepatitis. It is a worldwide health problem with approximately 170 million persons infected and areas of high endemicity in which the percentage of the population infected reaches 30%. It is a progressive disease that can lead to complications such as severe liver fibrosis and cirrhosis, ascites, esophageal varices, gastrointestinal bleeding and, in 30-50% of patients with cirrhosis, hepatocellular carcinoma. Extrahepatic pathologies such as mixed cryoglobulinemia, non-Hodgkin lymphoma and membrano-proliferative glomerulonephritis have been associated with HCV infection. Effective treatment exists, and is based on IFN-α. Sustained disappearance of the virus (sustained virological response) radically changes the natural history of chronic hepatitis C, with reduced or no disease progression and complications. Interferon-based treatment has improved over the years owing to the association with ribavirin and subsequently with 'pegylation' of interferon molecules. The present standard of care results in a response rate of up to 80% in some subpopulations. Nevertheless, some patients do not respond to this therapy. Several factors predicting nonresponse to interferon therapy have been investigated since it became available. These factors include the characteristics of the virus and of the subject infected, and the therapy used. The aim of this article is to provide an overview of these factors, and insights into the newly recognized causes of nonresponse to help clinicians select the most appropriate therapy for HCV viral hepatitis.
丙型肝炎病毒感染是慢性病毒性肝炎的一个非常常见的病因。它是一个全球性的健康问题，全球约有 1.7 亿人感染，且存在高流行地区，在这些地区，感染人口比例可达到 30%。这是一种进行性疾病，可导致严重的肝纤维化和肝硬化、腹水、食管静脉曲张、胃肠道出血，在 30-50%的肝硬化患者中还会导致肝细胞癌。丙型肝炎病毒感染还与肝外病变相关，如混合性冷球蛋白血症、非霍奇金淋巴瘤和膜增生性肾小球肾炎。有效的治疗方法是基于干扰素-α的。病毒持续消失（持续病毒学应答）从根本上改变了慢性丙型肝炎的自然病程，减少或没有疾病进展和并发症。由于与利巴韦林联合应用，随后与干扰素分子的“聚乙二醇化”联合应用，干扰素治疗近年来有所改善。目前的治疗标准在某些亚人群中可达到高达 80%的反应率。然而，一些患者对这种治疗没有反应。自干扰素治疗问世以来，已经研究了多种预测干扰素治疗无应答的因素。这些因素包括病毒和感染宿主的特征以及所使用的治疗方法。本文旨在概述这些因素，并深入了解新发现的无应答原因，以帮助临床医生为丙型肝炎病毒肝炎选择最合适的治疗方法。
