Muir Andrew J, Naggie Susanna
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Clin Gastroenterol Hepatol. 2015 Nov;13(12):2166-72. doi: 10.1016/j.cgh.2015.07.015. Epub 2015 Jul 17.
The recent advances in hepatitis C virus (HCV) therapeutics have brought combinations of direct acting antiviral medications that offer interferon-free, well-tolerated regimens with sustained virologic response rates greater than 90% in clinical trials for many patient groups. The successes have prompted discussions regarding cure for all patients. These regimens have already demonstrated the ability to cure previously challenging patient groups, including human immunodeficiency virus-HCV coinfection, decompensated cirrhosis, and post-liver transplantation. Limitations exist in the current portfolio of agents, with suboptimal outcomes for genotype 3 and limited data in genotypes 5 and 6. More data are urgently needed in patients with chronic kidney disease and in children. With ongoing developments, highly effective regimens for all these patient groups are within reach. To deliver HCV treatment throughout the world and particularly in low- and middle-income countries, regimens need to be affordable but also pan-genotypic, well-tolerated, and delivered once daily for 4-8 weeks. With such a regimen, cure for all patients would then hinge on the ability to identify patients with HCV infection and deliver treatment within their communities. This review will discuss the strategies that will be necessary to realize this opportunity to cure all persons with HCV infection.
丙型肝炎病毒（HCV）治疗方法的最新进展带来了直接作用抗病毒药物的联合使用，这些联合用药在许多患者群体的临床试验中提供了无干扰素、耐受性良好的治疗方案，病毒学持续应答率超过90%。这些成功引发了关于治愈所有患者的讨论。这些治疗方案已经证明有能力治愈以前具有挑战性的患者群体，包括人类免疫缺陷病毒-HCV合并感染、失代偿性肝硬化和肝移植后患者。目前的药物组合存在局限性，3型基因型患者的治疗效果欠佳，5型和6型基因型的数据有限。慢性肾病患者和儿童迫切需要更多数据。随着不断发展，针对所有这些患者群体的高效治疗方案即将实现。为了在全球范围内，特别是在低收入和中等收入国家提供HCV治疗，治疗方案需要价格可承受，而且要具备泛基因型、耐受性良好且每日给药一次、疗程为4至8周的特点。有了这样的治疗方案，治愈所有患者将取决于识别HCV感染患者并在其社区内提供治疗的能力。本综述将讨论实现治愈所有HCV感染患者这一目标所需的策略。
