Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Spain.
Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Spain.
J Hepatol. 2014 Nov;61(1 Suppl):S120-31. doi: 10.1016/j.jhep.2014.07.020. Epub 2014 Nov 3.
Interferon-based treatments have a poor safety profile and limited efficacy in patients with advanced liver disease and in patients with hepatitis C (HCV) recurrence after liver transplantation (LT). Despite the recent approval of the first interferon-free regimen, which will be followed by several other interferon-free combinations in 2014 and 2015, data in patients with advanced cirrhosis and hepatitis C after LT are still limited. One study has already proven the concept that graft HCV infection can be prevented in a significant proportion of patients by treating them with sofosbuvir and ribavirin while awaiting LT. Two interferon-free regimens have also demonstrated a high efficacy in patients with hepatitis C recurrence after transplantation. Before these treatment strategies can be implemented in clinical practice, a few issues need to be addressed: (1) safety and efficacy of new antivirals in patients with decompensated cirrhosis, (2) the impact of viral clearance on liver function, (3) the potential consequences of virological failure (and the selection of multi-drug resistant HCV strains) in patients with decompensated cirrhosis or with severe hepatitis C recurrence after LT, and (4) drug-drug interactions (DDI) profiles. Finally, in the transplant setting it is also relevant to learn which strategy is most cost-effective in minimizing the negative impact of hepatitis C: preventing graft infection by treating patients before transplantation or treating hepatitis C recurrence after LT.
基于干扰素的治疗方案在晚期肝病患者和肝移植（LT）后丙型肝炎（HCV）复发患者中的安全性和疗效均较差。尽管最近批准了首个无干扰素治疗方案，2014 年和 2015 年还将有其他几种无干扰素组合问世，但 LT 后晚期肝硬化和丙型肝炎患者的数据仍有限。一项研究已经证明，在等待 LT 的同时，用索非布韦和利巴韦林治疗，可以在很大一部分患者中预防移植物 HCV 感染。两种无干扰素方案在移植后 HCV 复发患者中也显示出很高的疗效。在这些治疗策略付诸临床实践之前，还需要解决几个问题：（1）新抗病毒药物在失代偿性肝硬化患者中的安全性和疗效；（2）病毒清除对肝功能的影响；（3）在失代偿性肝硬化或 LT 后严重 HCV 复发患者中病毒学失败的潜在后果（以及多药耐药 HCV 株的选择）；（4）药物相互作用（DDI）谱。最后，在移植环境中，了解哪种策略在将丙型肝炎的负面影响最小化方面最具成本效益也很重要：通过在移植前治疗患者来预防移植物感染，还是治疗 LT 后 HCV 复发。
