National Reference Center for Viral Hepatitis B, C and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; INSERM U955, Créteil, France.
Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Ontario, Canada.
J Hepatol. 2015 Apr;62(1 Suppl):S87-99. doi: 10.1016/j.jhep.2015.02.006.
The hepatitis C virus (HCV) was discovered in the late 1980s. Interferon (IFN)-α was proposed as an antiviral treatment for chronic hepatitis C at about the same time. Successive improvements in IFN-α-based therapy (dose finding, pegylation, addition of ribavirin) increased the rates of sustained virologic response, i.e. the rates of curing HCV infection. These rates were further improved by adding the first available direct-acting antiviral (DAA) drugs to the combination of pegylated IFN-α and ribavirin. An IFN-free era finally started in 2014, yielding rates of sustained virologic response over 90% in patients treated for 8 to 24 weeks with all-oral regimens. Major challenges however remain in implementation of these new treatment strategies, not only in low- to middle-income countries, but also in high-income countries where the price of these therapies is still prohibitive. Elimination of HCV infection through treatment in certain areas is possible but raises major public health issues.
丙型肝炎病毒 (HCV) 于 20 世纪 80 年代末被发现。大约在同一时间，干扰素 (IFN)-α 被提议作为慢性丙型肝炎的抗病毒治疗方法。基于 IFN-α 的治疗方法（剂量确定、聚乙二醇化、添加利巴韦林）的不断改进提高了持续病毒学应答率，即治愈 HCV 感染的比率。通过将第一批可用的直接作用抗病毒 (DAA) 药物添加到聚乙二醇化 IFN-α 和利巴韦林的联合治疗中，这些比率进一步提高。2014 年终于进入了无干扰素时代，接受 8 至 24 周全口服方案治疗的患者的持续病毒学应答率超过 90%。然而，在实施这些新的治疗策略方面仍然存在重大挑战，不仅在中低收入国家如此，在高收入国家也是如此，这些疗法的价格仍然令人望而却步。在某些地区通过治疗消除 HCV 感染是可能的，但这引发了重大的公共卫生问题。
