Second University of Naples, Internal Medicine and Hepatology, Department of Gerontology, Geriatrics and Metabolic Diseases, 80100 Naples, Italy.
Expert Opin Pharmacother. 2011 Oct;12(14):2215-34. doi: 10.1517/14656566.2011.597742. Epub 2011 Sep 2.
Chronic hepatitis C (HCV) infection is considered a metabolic disease. It is associated with a specific metabolic syndrome, HCV-associated dysmetabolic syndrome (HCADS), consisting of steatosis, hypocholesterolemia and insulin resistance/diabetes. These metabolic derangements contribute to a decrease in sustained virological response (SVR) to pegylated-interferon-α-ribavirin as standard of care (SOC), and are associated with progression of liver fibrosis.
The review, highlighting the impact of HCADS and metabolic syndrome components of HCV disease progression and SOC, discusses current knowledge and perspectives on metabolic therapeutic strategies aimed at improving SVR rate of SOC for chronic hepatitis C.
HCV, features of HCADS and of metabolic syndrome may coexist in the same patient, thus all components of the metabolic syndrome must be assessed to individualize treatment. The results of therapeutic trials evaluating metabolic strategies combined with current SOC indicate that weight loss is a critical part of treatment which will improve both disease outcome and therapeutic response to SOC. Similarly, statins seem to improve response rate to SOC representing, once confirmed to be safe, an important therapeutic tool for HCV-infected patients. Findings from studies using insulin sensitizers combined with SOC are not conclusive and do not justify the use of this class of drugs in clinical practice.
慢性丙型肝炎（HCV）感染被认为是一种代谢性疾病。它与一种特定的代谢综合征有关，即丙型肝炎相关代谢异常综合征（HCADS），包括脂肪变性、胆固醇降低和胰岛素抵抗/糖尿病。这些代谢紊乱会导致聚乙二醇干扰素-α-利巴韦林标准治疗（SOC）的持续病毒学应答（SVR）降低，并与肝纤维化的进展有关。
本文重点介绍了 HCADS 和代谢综合征成分对 HCV 疾病进展和 SOC 的影响，讨论了目前针对代谢治疗策略的知识和观点，这些策略旨在提高慢性丙型肝炎 SOC 的 SVR 率。
HCV、HCADS 的特征和代谢综合征可能同时存在于同一患者中，因此必须评估代谢综合征的所有成分，以实现个体化治疗。评估联合 SOC 的代谢策略的治疗试验结果表明，体重减轻是治疗的关键部分，这将改善疾病结局和 SOC 的治疗反应。同样，他汀类药物似乎可以提高 SOC 的应答率，这代表着一旦被证实安全，它们将成为 HCV 感染患者的重要治疗工具。使用 SOC 联合胰岛素增敏剂的研究结果并不确定，不能证明该类药物在临床实践中的使用。
