Beste Lauren A, Ioannou George N
Epidemiol Rev. 2015;37:131-43. doi: 10.1093/epirev/mxu002. Epub 2015 Jan 19.
Chronic hepatitis C virus (HCV) is the most common blood-borne pathogen in the United States. HCV disproportionately affects Veterans Affairs (VA) health-care users: 174,302 HCV-infected veterans were in VA care in 2013, making the VA the world's largest HCV care provider. This systematic review identified 546 articles related to HCV in the VA. After assessment by 2 independent reviewers, 28 articles describing prevalence and treatment of HCV in VA users ultimately met inclusion criteria. Most VA patients currently living with HCV infection were born between 1945 and 1965 and were infected with HCV between 1970 and 1990. To prevent HCV-related complications such as cirrhosis, hepatocellular carcinoma, and death, medical personnel must identify and treat HCV. However, antiviral therapy has historically been limited by medication side effects, contraindications, and patient acceptance. Although treatment initiation rates are higher in the VA than in the general United States, only 23% of VA HCV patients have received treatment and, of those, only a minority were cured. Recent development of more effective and tolerable antiviral agents represents a major pharmacological breakthrough. Eradication of HCV is theoretically possible for the majority of HCV patients for the first time, although new barriers, such as high drug costs, may limit future uptake.
慢性丙型肝炎病毒（HCV）是美国最常见的血源性病原体。HCV对退伍军人事务部（VA）的医疗保健使用者影响尤为严重：2013年，有174,302名感染HCV的退伍军人接受VA护理，这使VA成为全球最大的HCV护理提供者。这项系统评价确定了546篇与VA中HCV相关的文章。经过2名独立评审员的评估，最终有28篇描述VA使用者中HCV患病率和治疗情况的文章符合纳入标准。目前感染HCV的大多数VA患者出生于1945年至1965年之间，并且在1970年至1990年之间感染了HCV。为预防诸如肝硬化、肝细胞癌和死亡等与HCV相关的并发症，医务人员必须识别并治疗HCV。然而，抗病毒治疗在历史上一直受到药物副作用、禁忌症和患者接受度的限制。尽管VA中的治疗启动率高于美国总体水平，但只有23%的VA HCV患者接受了治疗，其中只有少数人被治愈。最近，更有效且耐受性更好的抗病毒药物的研发代表了一项重大的药理学突破。理论上首次有可能使大多数HCV患者根除HCV，尽管新的障碍，如高昂的药物成本，可能会限制未来的采用率。
