Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC
Med J Aust. 2016 Apr 18;204(7):268-72. doi: 10.5694/mja16.00106.
Chronic hepatitis C virus (HCV) infection affects 230 000 Australians, who are at risk of progressive liver fibrosis leading to cirrhosis, liver failure and hepatocellular carcinoma. HCV infection is curable, and all Australians living with HCV should be considered for antiviral therapy. Interferon-free regimens involving combinations of sofosbuvir, ledipasvir, daclatasvir and/or ribavirin for 8, 12 or 24 weeks are now listed on the Pharmaceutical Benefits Scheme (PBS) for treating people with genotypes 1-3 HCV. Treatment for genotypes 4-6 HCV involves sofosbuvir plus peginterferon-alfa and ribavirin for 12 weeks. The PBS listing allows these therapies to be prescribed by specialists experienced in treating chronic HCV infection or by general practitioners in consultation with one of these specialists. People with cirrhosis and other special populations (eg, those with decompensated liver disease or renal impairment) should be referred for specialist care. Key issues during pre-treatment assessment include identifying HCV genotype, evaluating for cirrhosis and considering concomitant medications for risk of drug-drug interactions.
慢性丙型肝炎病毒 (HCV) 感染影响了 23 万澳大利亚人，他们面临着进行性肝纤维化导致肝硬化、肝功能衰竭和肝细胞癌的风险。HCV 感染是可治愈的，所有患有 HCV 的澳大利亚人都应考虑进行抗病毒治疗。无干扰素方案包括索非布韦、来迪派韦、达拉他韦和/或利巴韦林联合治疗 8、12 或 24 周，现已列入药品福利计划 (PBS)，用于治疗基因型 1-3 HCV 患者。基因型 4-6 HCV 的治疗涉及索非布韦加聚乙二醇干扰素-α和利巴韦林治疗 12 周。PBS 清单允许由治疗慢性 HCV 感染经验丰富的专家或与这些专家之一协商的全科医生开这些疗法。肝硬化和其他特殊人群（例如，肝功能失代偿或肾功能损害的人群）应转至专家治疗。治疗前评估中的关键问题包括确定 HCV 基因型、评估肝硬化和考虑同时使用药物以避免药物相互作用的风险。
