Ansaldi Filippo, Orsi Andrea, Sticchi Laura, Bruzzone Bianca, Icardi Giancarlo
Filippo Ansaldi, Andrea Orsi, Laura Sticchi, Giancarlo Icardi, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy.
World J Gastroenterol. 2014 Aug 7;20(29):9633-52. doi: 10.3748/wjg.v20.i29.9633.
Despite the great successes achieved in the fields of virology and diagnostics, several difficulties affect improvements in hepatitis C virus (HCV) infection control and eradication in the new era. New HCV infections still occur, especially in some of the poorest regions of the world, where HCV is endemic and long-term sequelae have a growing economic and health burden. An HCV vaccine is still no available, despite years of researches and discoveries about the natural history of infection and host-virus interactions: several HCV vaccine candidates have been developed in the last years, targeting different HCV antigens or using alternative delivery systems, but viral variability and adaption ability constitute major challenges for vaccine development. Many new antiviral drugs for HCV therapy are in preclinical or early clinical development, but different limitations affect treatment validity. Treatment predictors are important tools, as they provide some guidance for the management of therapy in patients with chronic HCV infection: in particular, the role of host genomics in HCV infection outcomes in the new era of direct-acting antivirals may evolve for new therapeutic targets, representing a chance for modulated and personalized treatment management, when also very potent therapies will be available. In the present review we discuss the most recent data about HCV epidemiology, the new perspectives for the prevention of HCV infection and the most recent evidence regarding HCV diagnosis, therapy and predictors of response to it.
尽管在病毒学和诊断学领域取得了巨大成功，但在新时代，仍有几个困难影响丙型肝炎病毒（HCV）感染控制和根除工作的进展。新的HCV感染仍在发生，尤其是在世界上一些最贫困的地区，这些地区HCV呈地方性流行，长期后遗症带来的经济和健康负担日益加重。尽管对感染的自然史和宿主-病毒相互作用进行了多年研究和探索，但HCV疫苗仍未问世：近年来已研发出几种HCV候选疫苗，针对不同的HCV抗原或采用替代递送系统，但病毒变异性和适应能力对疫苗研发构成了重大挑战。许多用于HCV治疗的新型抗病毒药物正处于临床前或早期临床开发阶段，但不同的局限性影响了治疗的有效性。治疗预测指标是重要工具，因为它们为慢性HCV感染患者的治疗管理提供了一些指导：特别是在直接作用抗病毒药物的新时代，宿主基因组学在HCV感染结果中的作用可能会朝着新的治疗靶点发展，这为进行有针对性的个性化治疗管理带来了契机，届时也将有非常有效的治疗方法。在本综述中，我们讨论了有关HCV流行病学的最新数据、预防HCV感染的新观点以及有关HCV诊断、治疗及其反应预测指标的最新证据。
