Gaite Luis Alejandro, Marciano Sebastián, Galdame Omar Andrés, Gadano Adrián Carlos
Hepatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Hepat Med. 2014 May 27;6:35-43. doi: 10.2147/HMER.S57774. eCollection 2014.
Hepatitis C is the leading cause of chronic hepatitis, cirrhosis, and liver cancer in Argentina, where from 1.5% to 2.5% of adults are infected. Most of the infections were acquired 30-50 years ago. It is estimated that more than half of infected individuals are not aware of their infection. Even though the prevalence in blood donors has decreased to 0.45% at present, many high-prevalence populations still exist, where the reported prevalence ranges from 2.2% to 7.1%. Therapy is recommended for patients with fibrosis, in order to prevent disease progression, hepatic decompensation, and hepatocellular carcinoma. Great advances were achieved in the treatment of genotype 1 infection since the development and release of boceprevir and telaprevir. When either of these protease inhibitors is associated with peginterferon plus ribavirin, the sustained virological response (SVR) rate improves from 40%-50% to 67%-75%. For genotype 2 and 3 infection, treatment with peginterferon plus ribavirin is still the standard of care, with SVR rates of 70%-90%. There are significant new antivirals in development, and some of them are close to being released. These drugs will most likely be the future standard of care for all genotypes, and will be incorporated in better-tolerated and highly effective all-oral regimes. The impact that these new therapies might have in health-related economics is unpredictable, especially in developing countries. Each country must carefully evaluate the local situation in order to implement proper screening and treatment programs. Difficult-to-treat patients, such as those with decompensated cirrhosis, patients in hemodialysis, and those with other significant comorbidities, might not be able to receive these new therapeutic approaches and their management will remain challenging.
丙型肝炎是阿根廷慢性肝炎、肝硬化和肝癌的主要病因，该国1.5%至2.5%的成年人受到感染。大多数感染是在30至50年前获得的。据估计，超过一半的感染者不知道自己已被感染。尽管目前献血者中的患病率已降至0.45%，但仍存在许多高流行人群，报告的患病率在2.2%至7.1%之间。建议对纤维化患者进行治疗，以防止疾病进展、肝失代偿和肝细胞癌。自从博赛泼维（boceprevir）和特拉泼维（telaprevir）研发并上市以来，基因型1感染的治疗取得了巨大进展。当这些蛋白酶抑制剂中的任何一种与聚乙二醇干扰素加利巴韦林联合使用时，持续病毒学应答（SVR）率从40%-50%提高到67%-75%。对于基因型2和3感染，聚乙二醇干扰素加利巴韦林治疗仍然是标准治疗方案，SVR率为70%-90%。有一些重要的新型抗病毒药物正在研发中，其中一些已接近上市。这些药物很可能成为所有基因型未来的标准治疗方案，并将被纳入耐受性更好、疗效更高的全口服治疗方案中。这些新疗法可能对卫生相关经济学产生的影响是不可预测的，尤其是在发展中国家。每个国家都必须仔细评估当地情况，以便实施适当的筛查和治疗方案。难以治疗的患者，如失代偿性肝硬化患者、血液透析患者以及患有其他严重合并症的患者，可能无法接受这些新的治疗方法，对他们的管理仍将具有挑战性。
