Zoulim Fabien, Liang T Jake, Gerbes Alexander L, Aghemo Alessio, Deuffic-Burban Sylvie, Dusheiko Geoffrey, Fried Michael W, Pol Stanislas, Rockstroh Jürgen Kurt, Terrault Norah A, Wiktor Stefan
Université Lyon 1, Cancer Research Center of Lyon (CRCL), INSERM U1052, Hospices Civils de Lyon, Lyon, France.
Liver Diseases Branch, NIDDK, NIH, Bethesda, Maryland, USA.
Gut. 2015 Nov;64(11):1824-33. doi: 10.1136/gutjnl-2015-310421.
Chronic HCV infections represent a major worldwide public health problem and are responsible for a large proportion of liver related deaths, mostly because of HCV-associated hepatocellular carcinoma and cirrhosis. The treatment of HCV has undergone a rapid and spectacular revolution. In the past 5 years, the launch of direct acting antiviral drugs has seen sustained virological response rates reach 90% and above for many patient groups. The new treatments are effective, well tolerated, allow for shorter treatment regimens and offer new opportunities for previously excluded groups. This therapeutic revolution has changed the rules for treatment of HCV, moving the field towards an interferon-free era and raising the prospect of HCV eradication. This manuscript addresses the new challenges regarding treatment optimisation in the real world, improvement of antiviral efficacy in 'hard-to-treat' groups, the management of patients whose direct acting antiviral drug treatment was unsuccessful, and access to diagnosis and treatment in different parts of the world.
慢性丙型肝炎病毒（HCV）感染是一个重大的全球公共卫生问题，在与肝脏相关的死亡中占很大比例，主要原因是HCV相关的肝细胞癌和肝硬化。HCV的治疗经历了迅速而惊人的变革。在过去5年中，直接作用抗病毒药物的推出使许多患者群体的持续病毒学应答率达到90%及以上。新的治疗方法疗效显著、耐受性良好，治疗方案更短，并为以前被排除在外的群体提供了新机会。这场治疗革命改变了HCV的治疗规则，推动该领域迈向无干扰素时代，并提高了根除HCV的前景。本文探讨了现实世界中治疗优化、提高“难治性”群体的抗病毒疗效、直接作用抗病毒药物治疗失败患者的管理以及世界各地诊断和治疗可及性等方面的新挑战。
