基因型 4 慢性丙型肝炎的最佳治疗：终于治愈了？

Optimal therapy in genotype 4 chronic hepatitis C: finally cured?

机构信息

Hepatology Department, National Liver Institute, Menoufiya University, Menoufiya, Egypt.

出版信息

Liver Int. 2015 Jan;35 Suppl 1:27-34. doi: 10.1111/liv.12724.

Abstract

Optimal therapy for patients with hepatitis C virus (HCV) genotype 4 (HCV-4) infection is changing rapidly, and the possibility of a total cure is near. The standard of care has been combination pegylated interferon (PEG-IFN)-ribavirin (RBV), with modest response rates and considerable adverse events. Since the introduction of sofosbuvir (SOF), simeprevir (SIM), and daclatasvir (DCV), the duration of treatment has been significantly shortened and response rates have increased. The recommended treatment for IFN-eligible patients is PEG-IFN/RBV plus SOF, SIM or DCV. In IFN ineligible patients, the optimal regimen is a 24-week course of SOF/RBV, or a 12-week course of SOF-SIM or SOF-DCV with or without RBV. The pipeline for patients with chronic HCV is highly active. IFN-free combinations with paritaprevir-ombitasvir, SOF-ledipasvir, or DCV-asunaprevir (ASV)-beclabuvir (BMS-791325) for 12 weeks or less with close to 100% cure rates will soon become the optimal therapy.

摘要

对于丙型肝炎病毒（HCV）基因型 4 （HCV-4）感染患者的最佳治疗方法正在迅速改变，完全治愈的可能性已经临近。标准治疗方法一直是聚乙二醇干扰素（PEG-IFN）联合利巴韦林（RBV），但应答率较低且不良反应较多。自从引入索非布韦（SOF）、西美瑞韦（SIM）和达卡他韦（DCV）以来，治疗时间已经大大缩短，应答率也有所提高。推荐用于 IFN 合格患者的治疗方案是 PEG-IFN/RBV 加 SOF、SIM 或 DCV。对于 IFN 不合格患者，最佳方案是 SOF/RBV 治疗 24 周，或 SOF-SIM 或 SOF-DCV 联合或不联合 RBV 治疗 12 周。慢性 HCV 患者的治疗方案具有高度活性。无干扰素联合帕利昔洛韦、SOF-雷迪帕韦或 DCV-阿舒瑞韦（ASV）-贝昔洛韦（BMS-791325），疗程为 12 周或更短，治愈率接近 100%，将很快成为最佳治疗方案。