Department of Medicine, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, New Haven, Connecticut.
Gastroenterology. 2017 May;152(6):1578-1587. doi: 10.1053/j.gastro.2017.03.018. Epub 2017 Mar 23.
Chronic hepatitis C virus infection is well-recognized as a common blood-borne infection with global public health impact affecting 3 to 5 million persons in the United States and more than 170 million persons worldwide. Chronic hepatitis C virus infection is associated with significant morbidity and mortality due to complications of liver cirrhosis and hepatocellular carcinoma. Current therapies with all-oral direct-acting antiviral agents are associated with high rates of sustained virologic response (SVR), generally exceeding 90%. SVR is associated with a reduced risk of liver cirrhosis, hepatic decompensation, need for liver transplantation, and both liver-related and all-cause mortality. However, a subset of patients who achieve SVR will remain at long-term risk for progression to cirrhosis, liver failure, hepatocellular carcinoma, and liver-related mortality. Limited evidence is available to guide clinicians on which post-SVR patients should be monitored vs discharged, how to monitor and with which tests, how frequently should monitoring occur, and for how long. In this clinical practice update, available evidence and expert opinion are used to generate best practice recommendations on the care of patients with chronic hepatitis C virus who have achieved SVR.
慢性丙型肝炎病毒感染是一种常见的血源感染，具有全球公共卫生影响，在美国影响 300 至 500 万人，在全球影响超过 1.7 亿人。慢性丙型肝炎病毒感染可导致肝硬化和肝细胞癌等并发症，从而导致较高的发病率和死亡率。目前采用的全口服直接作用抗病毒药物治疗方案具有较高的持续病毒学应答率（SVR），一般超过 90%。SVR 可降低肝硬化、肝功能失代偿、肝移植需求以及与肝脏相关和所有原因的死亡率的风险。然而，有一部分 SVR 患者仍存在长期发展为肝硬化、肝功能衰竭、肝细胞癌和与肝脏相关的死亡的风险。目前仅有有限的证据可指导临床医生选择应监测哪些 SVR 患者以及何时停止监测，如何监测以及使用哪些检测方法，监测的频率以及持续时间。在本临床实践更新中，利用现有证据和专家意见，为实现 SVR 的慢性丙型肝炎病毒感染者的护理制定最佳实践建议。
