Department of Medicine, Cedars-Sinai Medical Center, 8635 W Third St, Ste 1060, Los Angeles, CA 90048, USA.
Am J Manag Care. 2011 Mar;17 Suppl 4:S123-30.
The current standard of care for patients with chronic hepatitis C virus (HCV) infection is pegylated interferon alfa in combination with ribavirin. Treatment duration and efficacy depend heavily on HCV genotype. A sustained virologic response (SVR) is achieved only in approximately 40% of patients. Side effects of the current standard of care often make adherence to therapy difficult, further reducing the chance for an SVR. Numerous patient-related and virus-related factors can determine response to treatment. Nonresponders are a large proportion of the current HCV-infected population, and the number of patients with HCV infection is growing, necessitating newer therapies with higher efficacy and potentially fewer side effects. A new era of direct acting antiviral (DAA) compounds has emerged. The first 2 protease inhibitors for HCV infection, telaprevir and boceprevir, are coming to market in 2011. Other protease compounds in development include TMC-435, vaniprevir, BI-201335, BMS-650032, and danoprevir. The numerous other therapies that have potential in the treatment of HCV infection include nucleoside inhibitors, non-nucleoside inhibitors, NS5A inhibitors, DAA combinations, therapeutic vaccines, human monoclonal antibodies, immune modifiers, and interferon lambda.
目前慢性丙型肝炎病毒（HCV）感染患者的标准治疗方法是聚乙二醇干扰素 alfa 联合利巴韦林。治疗持续时间和疗效在很大程度上取决于 HCV 基因型。只有约 40%的患者能够达到持续病毒学应答（SVR）。目前标准治疗方法的副作用常常使治疗依从性变得困难，进一步降低了 SVR 的机会。许多与患者相关和与病毒相关的因素可以决定治疗反应。无应答者是当前 HCV 感染人群中的很大一部分，而且 HCV 感染患者的数量正在增加，这需要更有效且可能副作用更少的新型疗法。直接作用抗病毒（DAA）化合物的新时代已经到来。2011 年，第一批用于 HCV 感染的 2 种蛋白酶抑制剂 telaprevir 和 boceprevir 即将上市。其他正在开发中的蛋白酶化合物包括 TMC-435、vaniprevir、BI-201335、BMS-650032 和 danoprevir。其他具有治疗 HCV 感染潜力的众多疗法包括核苷抑制剂、非核苷抑制剂、NS5A 抑制剂、DAA 联合治疗、治疗性疫苗、人单克隆抗体、免疫调节剂和干扰素 lambda。
