Department of Internal Medicine III, Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
J Viral Hepat. 2012 Jan;19 Suppl 1:7-13. doi: 10.1111/j.1365-2893.2011.01522.x.
The rapidity of viral disappearance on antiviral treatment of chronic hepatitis C with peginterferon/ribavirin correlates with the cure rate. The earlier the virus becomes undetectable, the higher are the response rates. This observation is the basis of response-guided therapy. Viral clearance within the first 4 weeks of treatment is called a rapid virologic response (RVR). The rate of RVR varies among various populations, with the highest one observed in Asian patients and the lowest in African-Americans. In patients infected with genotypes 1 and 4 who experience a RVR treatment with peginterferon/ribavirin can be shortened to just 24 weeks without losing efficacy (sustained virologic rate in RVR are >80%). In contrast, patients with a slow decline in viral load (> 2 log drop after 12 weeks with still detectable virus) may benefit from treatment extension to 72 weeks. Prolonged treatment reduces relapse rates but has no significant effect on cure rates. The data in patients with genotypes 2 and 3 are less clear, mostly because these genotypes are much easier to cure and a benefit is hard to detect. Nevertheless in patients with RVR and low baseline viral load treatment can be safely shortened to 16 weeks. The recently described polymorphism in the region of the IL28B gene may help to select patients for abbreviated or extended treatment schedules.
聚乙二醇干扰素/利巴韦林治疗慢性丙型肝炎的病毒快速消失与治愈率相关。病毒越早检测不到，应答率越高。这一观察结果是基于应答指导治疗的基础。治疗的第 4 周内病毒清除称为快速病毒学应答（RVR）。RVR 在不同人群中的发生率不同，亚洲患者的发生率最高，而非洲裔美国人的发生率最低。在感染基因型 1 和 4 的患者中，如果出现 RVR，聚乙二醇干扰素/利巴韦林的治疗可以缩短至 24 周而不降低疗效（RVR 的持续病毒学应答率>80%）。相比之下，病毒载量下降缓慢（12 周后仍可检测到病毒，但下降幅度>2 对数）的患者可能受益于治疗延长至 72 周。延长治疗可降低复发率，但对治愈率无显著影响。基因型 2 和 3 患者的数据不太明确，主要是因为这些基因型更容易治愈，而且难以发现益处。然而，在 RVR 和低基线病毒载量的患者中，治疗可以安全地缩短至 16 周。最近在 IL28B 基因区域描述的多态性可能有助于选择患者进行缩短或延长治疗方案。
