Tural Cristina, Planas Ramon
Unidad Clínica de VIH, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, España.
Enferm Infecc Microbiol Clin. 2013 Jul;31 Suppl 3:19-25. doi: 10.1016/S0213-005X(13)70120-4.
Triple combination therapy with pegylated interferon, ribavirin and telaprevir is currently considered the gold standard for the treatment of chronic hepatitis C virus (HCV) infection. The most important features are an increase in rates of sustained viral response (74-79% vs 46% with pegylated interferon and ribavirin), as well as the possibility of early cessation of ineffective therapy due to the application of futility rules at weeks 4 and 12 (HCV-RNA > 1,000 UI/ml), and the possibility of selecting candidates for the shortest treatments due to the clinical significance of extended rapid viral response (undetectable HCV-RNA at weeks 4 and 12 of triple therapy). Treatment length is mainly based on the stage of fibrosis and prior response to pegylated interferon and ribavirin. Thus, in both treatment-naïve patients and patients with recurrence after pegylated interferon therapy, the duration of treatment is 24 or 48 weeks (unless cirrhosis is present), depending on the presence of extended rapid viral response, while in cirrhotic patients and null responders, treatment length is 48 weeks. The main adverse effects of telaprevir therapy are anemia and skin rash. If these effects occur, the main measures that should be adopted are reduction of the ribavirin dose in anemia, and close monitoring and treatment cessation in skin rash, depending on its spread and severity.
聚乙二醇干扰素、利巴韦林和特拉匹韦的三联组合疗法目前被认为是治疗慢性丙型肝炎病毒（HCV）感染的金标准。其最重要的特点是持续病毒学应答率提高（74 - 79%，而聚乙二醇干扰素和利巴韦林联合治疗的应答率为46%），以及由于在第4周和第12周应用无效治疗规则（HCV-RNA>1000 UI/ml）而有可能提前停止无效治疗，并且由于延长快速病毒应答（三联疗法第4周和第12周时HCV-RNA检测不到）的临床意义而有可能选择接受最短疗程治疗的患者。治疗时长主要基于纤维化阶段以及既往对聚乙二醇干扰素和利巴韦林的应答情况。因此，对于初治患者以及聚乙二醇干扰素治疗后复发的患者，治疗时长为24周或48周（除非存在肝硬化），这取决于是否存在延长快速病毒应答，而对于肝硬化患者和无应答者，治疗时长为48周。特拉匹韦治疗的主要不良反应是贫血和皮疹。如果出现这些不良反应，应采取的主要措施是，对于贫血，减少利巴韦林剂量；对于皮疹，则根据其扩散程度和严重程度密切监测并停止治疗。
