Bartenschlager R, Cornberg M, Pietschmann T
Zentrum für Infektiologie, Molekulare Virologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 345, 69120, Heidelberg, Deutschland.
Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.
Internist (Berl). 2017 Jul;58(7):666-674. doi: 10.1007/s00108-017-0262-8.
Precision medicine is also possible for infectious diseases as shown for the treatment of chronic viral hepatitis, especially if different options are available. In hepatitis B virus (HBV) infection, treatment indication as well as the choice of treatment and the decisions to stop treatment are based on viral markers and alanine aminotransferase (ALT) level. Future therapies for HBV infection aiming for functional cure or even virus elimination may be even more personalized and have to take into account the immune status of a given patient. Such treatment modalities might also increase the chance for successful treatment of chronic hepatitis delta where treatment options are still very limited. Some new therapeutic concepts targeting host receptors or host enzymes are promising, but may require individualized approaches. Chronic hepatitis C is a good example for precision medicine based on viral and host factors. However, the main reason for individualized direct-acting antiviral (DAA) treatment is to save costs. As DAAs are effective in more than 95% of patients, elimination of HCV seems to be possible at the level of a given country or even on a global scale. However, owing to high reinfection rates in high-risk groups and limited availability of antiviral therapy in many high endemic countries, it must still be decided whether an HCV vaccine or pre-exposure prophylaxis is required to achieve this goal. Hepatitis E is an emerging topic as this is the most frequent acute hepatitis virus infection. It can result in a chronic infection in immunosuppressed individuals. Treatment options are still limited and individualized management is based on tailoring immunosuppressive therapy and therapy with ribavirin. Thus, personalized therapy of hepatitis E virus infection is still limited.
对于传染病来说，精准医学也是可行的，如慢性病毒性肝炎的治疗所示，尤其是在有不同治疗选择的情况下。在乙型肝炎病毒（HBV）感染中，治疗指征、治疗选择以及停药决定均基于病毒标志物和丙氨酸转氨酶（ALT）水平。未来针对HBV感染旨在实现功能性治愈甚至病毒清除的疗法可能会更加个性化，并且必须考虑特定患者的免疫状态。这种治疗方式也可能增加成功治疗丁型肝炎的机会，目前丁型肝炎的治疗选择仍然非常有限。一些针对宿主受体或宿主酶的新治疗概念很有前景，但可能需要个体化方法。丙型肝炎是基于病毒和宿主因素进行精准医学治疗的一个很好的例子。然而，个体化直接抗病毒药物（DAA）治疗的主要原因是节省成本。由于DAA对超过95%的患者有效，在一个特定国家甚至全球范围内消除丙型肝炎病毒似乎是可能的。然而，由于高危人群的再感染率高，且许多高流行国家的抗病毒治疗可及性有限，仍需决定是否需要丙型肝炎疫苗或暴露前预防措施来实现这一目标。戊型肝炎是一个新出现的话题，因为它是最常见的急性肝炎病毒感染。它可在免疫抑制个体中导致慢性感染。治疗选择仍然有限，个体化管理基于调整免疫抑制治疗和利巴韦林治疗。因此，戊型肝炎病毒感染的个性化治疗仍然有限。
