Ryder Stephen D
Nottingham University Hospitals NHS Trust and Biomedical Research Unit, Queens Medical Centre, Nottingham, UK
Clin Med (Lond). 2015 Apr;15(2):197-200. doi: 10.7861/clinmedicine.15-2-197.
Until recently in the UK the treatment of HCV depended on combination regimes of interferon (IFN) and the antiviral drug ribavirin. These regimes required regular injections and were of variable duration (generally for a minimum of 12 weeks), and the use of IFN often caused unacceptable side effects (thrombocytopenia, leukopenia and depression). Of the common HCV genotypes in the UK, genotype 1 responded relatively poorly to these regimes (50-60% viral clearance), while most (80% plus) of genotype 3 patients responded with sustained viral clearance. Patients with severe liver disease (decompensated cirrhosis) tolerated these regimens very poorly and often their liver function deteriorated. The recent introduction of a series of direct anti-viral agents (DAAs) offers the potential to revolutionise treatment, particularly in genotype 1 patients and those with advanced liver disease, as drug regimens avoiding IFN have been developed, and can be curative in, for example, 95% of genotype 1 patients. The DAAs are currently being evaluated and introduced into UK clinical practice. Choice of drug regime, and strategies for identifying patient groups suitable for treatment, are discussed, as are the prospects for eventual complete control of the HCV epidemic.
直到最近，英国对丙型肝炎病毒（HCV）的治疗依赖于干扰素（IFN）和抗病毒药物利巴韦林的联合治疗方案。这些方案需要定期注射，疗程长短不一（一般至少12周），而且使用干扰素常常会引起难以接受的副作用（血小板减少、白细胞减少和抑郁）。在英国常见的HCV基因型中，1型基因型对这些方案的反应相对较差（病毒清除率为50 - 60%），而大多数（80%以上）3型基因型患者的病毒得以持续清除。患有严重肝病（失代偿性肝硬化）的患者对这些治疗方案的耐受性非常差，而且他们的肝功能常常会恶化。最近一系列直接抗病毒药物（DAAs）的推出为治疗带来了变革的潜力，特别是对于1型基因型患者和那些患有晚期肝病的患者，因为已经开发出了避免使用干扰素的药物方案，例如，在95%的1型基因型患者中可以实现治愈。目前正在对DAAs进行评估并引入英国的临床实践。文中讨论了药物方案的选择、识别适合治疗的患者群体的策略，以及最终完全控制HCV流行的前景。
