Viganò Mauro, Perno Carlo Federico, Craxì Antonio
Hepatology Unit, Ospedale San Giuseppe, University of Milan, Milan, Italy.
Virology Unit, Department of Experimental Medicine and Surgery, "Tor Vergata" University of Rome, Rome, Italy.
Dig Liver Dis. 2017 Jul;49(7):731-741. doi: 10.1016/j.dld.2017.03.027. Epub 2017 Apr 12.
Hepatitis C virus (HCV) infection remains one of the main causes of chronic liver disease worldwide. The advent of direct-acting antivirals (DAAs) has significantly improved the course of patients with chronic HCV infection (CHC), due to the ability of these drugs to achieve high rates of sustained virological response (SVR). These exceedingly high rates of SVR and the excellent safety data have been confirmed in real life practice. Evolving guidelines have been issued by national and international scientific societies in accordance with the progression of clinical knowledge and the availability of new DAAs. These recommendations, however, may not be applied universally because of delays in drugs reimbursability in different countries and because some National Health Systems identify only patients with advanced disease as a treatment priority. Italy in this regard is a prototype about DAAs treatment of CHC patients. With the aim to assess the Italian treatment experience with DAAs and to respond to unmet needs in treatment optimization of antiviral therapy in specific settings of CHC patients, a group of Italian experts met in Stresa in February 2017. The summary of the considerations arising from this two-day meeting and some statements regarding a few open issues are reported in this position paper.
丙型肝炎病毒（HCV）感染仍是全球慢性肝病的主要病因之一。直接抗病毒药物（DAAs）的出现显著改善了慢性HCV感染（CHC）患者的病程，因为这些药物能够实现高比例的持续病毒学应答（SVR）。这些极高的SVR率和出色的安全性数据已在实际临床实践中得到证实。随着临床知识的进展以及新型DAAs的出现，国家和国际科学协会发布了不断更新的指南。然而，由于不同国家药物报销延迟，以及一些国家卫生系统仅将晚期疾病患者作为治疗优先对象，这些建议可能无法普遍适用。在这方面，意大利是CHC患者DAAs治疗的一个典型例子。为了评估意大利使用DAAs的治疗经验，并回应CHC患者特定情况下抗病毒治疗优化中未满足的需求，一群意大利专家于2017年2月在斯特雷萨举行了会议。本立场文件报告了此次为期两天会议产生的审议总结以及关于一些未决问题的一些声明。
