Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK.
Aliment Pharmacol Ther. 2016 Jul;44(2):145-56. doi: 10.1111/apt.13673. Epub 2016 May 20.
Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide. HCV predominates in people who inject drugs; a group in whom anti-viral therapy has previously been withheld on the basis of chaotic lifestyles and associated risks of reinfection. New research has emerged which suggests that by specifically targeting HCV-infected people who inject drugs for treatment, the pool of HCV would deplete, thus reducing overall transmission and eventually leading to HCV eradication.
To outline the requirements for HCV eradication and review the evidence that this is achievable.
Expert review of the literature.
The achievement of HCV eradication using 'treatment as prevention' is supported by numerous epidemiological modelling studies employing a variety of models in several contexts including people who inject drugs, men who have sex with men and prisoners. More recent studies also incorporate the newer, more efficacious direct-acting anti-viral drugs. These drugs have been shown to be safe and effective in people who inject drugs in clinical trials. There is no empirical evidence of the impact of treatment as prevention strategies on population prevalence.
This review highlights the efforts to control HCV and evaluates the possibilities of achieving eradication of HCV. Currently, the technologies required to achieve HCV eradication exist, but the infrastructure to deliver them is not generally available or of insufficient scale outside of specific areas. Such areas are yet to demonstrate that elimination is possible, but results of studies in these areas are awaited. Such a demonstration would be proof of principle for eradication. Although we are aspiring towards HCV eradication, elimination is the more realistic prospect.
丙型肝炎病毒（HCV）是全球慢性肝病的主要病因。HCV 在注射毒品人群中占主导地位；由于生活方式混乱以及再次感染的相关风险，这些人群之前一直被排除在抗病毒治疗之外。新的研究表明，通过专门针对注射毒品的 HCV 感染者进行治疗，可以耗尽 HCV 病毒库，从而减少整体传播，并最终导致 HCV 被根除。
概述 HCV 根除的要求，并回顾实现这一目标的证据。
对文献进行专家审查。
多项流行病学模型研究采用多种模型，在包括注射毒品者、男男性行为者和囚犯在内的不同环境中，均支持使用“治疗即预防”来实现 HCV 根除。最近的研究还纳入了更新型、更有效的直接作用抗病毒药物。这些药物在临床试验中已被证明对注射毒品者是安全有效的。目前尚无治疗即预防策略对人群流行率影响的经验证据。
本综述强调了控制 HCV 的努力，并评估了实现 HCV 根除的可能性。目前，实现 HCV 根除所需的技术已经存在，但在特定地区之外，提供这些技术的基础设施并不普遍或规模不足。这些地区尚未证明消除是可能的，但正在等待这些地区的研究结果。这样的证明将是根除的原则性证明。尽管我们渴望实现 HCV 根除，但消除是更现实的前景。
