Yu Ming-Lung, Yeh Ming-Lun, Tsai Pei-Chien, Huang Ching-I, Huang Jee-Fu, Huang Chung-Feng, Hsieh Meng-Hsuan, Liang Po-Cheng, Lin Yi-Hung, Hsieh Ming-Yen, Lin Wen-Yi, Hou Nai-Jen, Lin Zu-Yau, Chen Shinn-Cherng, Dai Chia-Yen, Chuang Wan-Long, Chang Wen-Yu
From the Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital (Ming-Lung Yu, Ming-Lun Yeh, P-CT, J-FH, C-FH, P-CL, Y-HL, M-YH, Z-YL, S-CC, C-YD, W-LC, W-YC); Faculty of Internal Medicine, College of Medicine, and Graduate Institute of Clinical Medicine, and Center for Infectious Disease and Cancer Research, Kaohsiung Medical University (Ming-Lung Yu, J-FH, C-FH, M-HH, Z-YL, S-CC, C-YD, W-LC); Institute of Biomedical Sciences, National Sun Yat-Sen University (Ming-Lung Yu); Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (C-IH, N-JH); Department of Occupational Medicine, Kaohsiung Municipal Ta-Tung Hospital (C-FH); Department of Preventive Medicine, Kaohsiung Medical University Hospital (M-HH); Department of Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (W-YL); and Taiwan Liver Research Foundation, Kaohsiung, Taiwan (W-YC).
Medicine (Baltimore). 2015 Apr;94(13):e690. doi: 10.1097/MD.0000000000000690.
Peginterferon/ribavirin provides a substantially high treatment efficacy for chronic hepatitis C virus (HCV) infections in Asians. Whether the clinical efficacy can be translated to community effectiveness remains unclear. The disease awareness, treatment accessibility, recommendations, acceptance, and barriers to anti-HCV treatment were explored to clarify the issue with a 3-step nationwide investigation in Taiwan. A crude HCV-infected population was estimated using databases from 3 large-scale surveillance studies and age-/geographic-specific population database. HCV awareness and accessibility were investigated at the patient level in 58,129 residents. The recommendations/acceptances and barriers to treatment at the provider level were evaluated using a prospective, nationwide approach to 89 gastroenterologists/hepatologists. The estimated 10-year interval age-adjusted anti-HCV-seropositive population is 745,109 (3.28%), with an anticipated HCV-viremic population of 554,361. Of anti-HCV-seropositive subjects, 36.2% had disease awareness. Among those with awareness, 39.6% had accessibility. The recommendation/acceptance rate of antiviral therapy was 70.6%. The treatment rate was 10.1% and 13.7% for the anti-HCV-seropositive and HCV-viremic population, respectively. With an anticipated treatment success rate of 80% in Taiwan, 8.1% of the anti-HCV-seropositive and 10.9% of the HCV-viremic population achieved successful treatment. The major treatment barriers were fear of adverse effects (37%), major disorders (17.6%), ineligibility for insurance reimbursement (17.6%), and lack of therapy awareness (11.3%). Despite the high rates of treatment response and nationwide coverage of insurance reimbursement, there remains a large gap between clinical efficacy and community effectiveness in anti-HCV treatment in Taiwan. Increasing disease awareness/treatment accessibility and introducing new therapeutic strategies with high tolerability are warranted.
聚乙二醇干扰素/利巴韦林对亚洲慢性丙型肝炎病毒（HCV）感染具有相当高的治疗效果。但其临床疗效能否转化为社区治疗效果仍不清楚。为了阐明这一问题，在台湾进行了一项全国性的三步调查，探讨了疾病认知、治疗可及性、建议、接受度以及抗HCV治疗的障碍。利用3项大规模监测研究和年龄/地域特异性人口数据库估算HCV粗感染人群。在58129名居民中对患者层面的HCV认知和可及性进行了调查。采用前瞻性全国性方法对89名胃肠病学家/肝病学家评估了医疗服务提供者层面的治疗建议/接受度和障碍。估计10年间年龄调整后的抗HCV血清阳性人群为745109人（3.28%），预计HCV病毒血症人群为554361人。在抗HCV血清阳性受试者中，36.2%知晓病情。在知晓病情者中，39.6%有治疗可及性。抗病毒治疗的建议/接受率为70.6%。抗HCV血清阳性人群和HCV病毒血症人群的治疗率分别为10.1%和13.7%。预计台湾的治疗成功率为80%，抗HCV血清阳性人群中有8.1%、HCV病毒血症人群中有10.9%获得了成功治疗。主要治疗障碍包括担心不良反应（37%）、严重疾病（17.6%）、不符合保险报销条件（17.6%）以及缺乏治疗意识（11.3%）。尽管治疗反应率高且保险报销覆盖全国，但台湾抗HCV治疗的临床疗效与社区治疗效果之间仍存在较大差距。有必要提高疾病认知/治疗可及性，并引入耐受性高的新治疗策略。
