Zhang L, Gwinn M, Hu D J
Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
Public Health Genomics. 2013;16(4):192-7. doi: 10.1159/000352014. Epub 2013 Jul 11.
About 180 million people worldwide are chronically infected with hepatitis C virus (HCV), with 3-4 million newly infected each year. Only 15-25% of acute HCV infections clear spontaneously, and the remainder persists as chronic HCV infection. More than 350,000 people die every year from hepatitis C-related liver failure and cancer. There is currently no vaccine and the standard-of-care therapies--peg-interferon alpha (pegIFN) plus ribavirin (RBV)--are expensive and have serious side effects. Also, they may be effective in only 40-50% of patients infected with HCV genotype 1, the most common HCV genotype in the US. Interleukin 28B (IL28B) genotype was recently and convincingly associated with response to pegIFN and RBV therapy. It has emerged as a robust pretreatment predictor of sustained virological response (SVR, i.e. virologic clearance) to pegIFN and RBV as well as to new triple therapy regimens that include a direct-acting antiviral agent with pegIFN and RBV and increase SVR rates as much as 75% in patients infected with HCV genotype 1. Testing for IL28B genotype may contribute to clinical decision-making and could inform clinical guidelines and public health policies.
全球约有1.8亿人慢性感染丙型肝炎病毒（HCV），每年新增感染病例300万至400万。急性HCV感染中只有15% - 25%会自发清除，其余则会持续成为慢性HCV感染。每年有超过35万人死于丙型肝炎相关的肝衰竭和癌症。目前尚无疫苗，而标准治疗方案——聚乙二醇化干扰素α（pegIFN）联合利巴韦林（RBV）——费用高昂且有严重副作用。此外，它们对感染HCV基因1型（美国最常见的HCV基因型）的患者可能仅40% - 50%有效。白细胞介素28B（IL28B）基因型最近被明确证实与对pegIFN和RBV治疗的反应相关。它已成为对pegIFN和RBV以及包括直接抗病毒药物与pegIFN和RBV联用的新三联疗法方案持续病毒学应答（SVR，即病毒学清除）的有力治疗前预测指标，可使感染HCV基因1型的患者SVR率提高多达75%。检测IL28B基因型可能有助于临床决策，并可为临床指南和公共卫生政策提供参考。
