Hughes Heather Y, Henderson David K
aCharlie Norwood VA Medical Center, Augusta, Georgia, USA bClinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Curr Opin Infect Dis. 2016 Aug;29(4):373-80. doi: 10.1097/QCO.0000000000000281.
Healthcare personnel are at risk for occupational exposures to bloodborne pathogens. Primary prevention remains the first line of defense, but secondary prevention measures known to be effective should be implemented when percutaneous exposures occur. Hepatitis C virus (HCV) is a major infectious cause of liver-related morbidity and mortality. Chronic HCV treatment has changed dramatically, with many all-oral directly acting anti-HCV antiviral (DAA) regimens now available. Evidence for the use of DAAs as postexposure prophylaxis (PEP) after occupational exposures to HCV is summarized here.
Little new evidence supports the use of antivirals in acute HCV infection. Several preliminary studies have examined the use of DAAs or host target agents in chronic HCV treatment. Effective HCV PEP requirements likely include pan-genotypic activity and a high barrier to resistance. One investigational DAA has shown promising results as an efficacious option for all genotypes in chronic HCV treatment and may ultimately represent a potential HCV PEP agent.
Insufficient supporting data exist to endorse the use of DAAs for PEP after HCV occupational exposures; additional studies examining efficacy, duration, and cost-effectiveness are needed. Development of more oral drugs possessing a high barrier of resistance and equal activity against all HCV genotypes is anticipated.
医护人员面临职业性接触血源性病原体的风险。一级预防仍然是第一道防线，但在发生经皮暴露时，应实施已知有效的二级预防措施。丙型肝炎病毒（HCV）是导致肝脏相关发病和死亡的主要感染原因。慢性HCV治疗已发生显著变化，现在有许多全口服的直接作用抗HCV抗病毒药物（DAA）方案。本文总结了职业性接触HCV后使用DAA进行暴露后预防（PEP）的证据。
几乎没有新证据支持在急性HCV感染中使用抗病毒药物。几项初步研究探讨了DAA或宿主靶向药物在慢性HCV治疗中的应用。有效的HCV PEP要求可能包括泛基因型活性和高耐药屏障。一种研究性DAA在慢性HCV治疗中对所有基因型均显示出有前景的有效结果，最终可能成为一种潜在的HCV PEP药物。
目前尚无足够的支持数据认可在HCV职业暴露后使用DAA进行PEP；需要更多关于疗效、疗程和成本效益的研究。预计会开发出更多具有高耐药屏障且对所有HCV基因型均有同等活性的口服药物。
