Shanghai Roche Pharmaceuticals Ltd., Shanghai 201203, Beijing, China.
Liver Disease Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):470-479. doi: 10.1016/S1499-3872(17)60044-4.
The availability of novel direct-acting antivirals (DAAs) represents a new era of curative hepatitis C virus (HCV) treatment, with over 95% of patients infected with HCV genotype 1 achieving sustained virological response (SVR). Nevertheless, the majority of patients globally are unable to access these treatments because of cost and infrastructure constraints and, thus, remain untreated and uncured.
Relevant articles of peginterferon (PegIFN)-based treatments in HCV and sofosbuvir-based treatments, simeprevir, daclatasvir/asunaprevir, ritonavir-boosted paritaprevir/ombitasvir/dasabuvir, and grazoprevir/elbasvir, were searched in PubMed database, including general population and special population.
PegIFN in combination with ribavirin remains an important and relevant option for some patients, achieving SVR rates of up to 79% in genotype 1 and 89% in genotype 2 or 3 infections, which increases for patients with favorable IL28B genotypes. Triple therapy of DAA plus PegIFN/ribavirin is effective in treating difficult-to-cure patients infected with HCV genotype 3 or with resistance-associated variants. Owing to its long history in HCV management, the efficacy, tolerability and long-term outcomes associated with PegIFN alfa-2a are well established and have been validated in large-scale studies and in clinical practice for many populations. Furthermore, emerging data show that IFN-induced SVR is associated with lower incidences of hepatocellular carcinoma compared with DAAs. On the contrary, novel DAAs have yet to be studied in special populations, and long-term outcomes, particularly tumor development and recurrence in patients with cirrhosis and/or hepatocellular carcinoma, and reactivation of HBV in dually infected patients, are still unclear.
In this interferon-free era, PegIFN-based regimens remain a safe and effective option for selected HCV patients.
新型直接作用抗病毒药物（DAAs）的出现代表了治疗丙型肝炎病毒（HCV）的新时代，超过 95%的感染 HCV 基因 1 型的患者达到持续病毒学应答（SVR）。然而，由于成本和基础设施的限制，全球大多数患者无法获得这些治疗方法，因此仍然未得到治疗和治愈。
在 PubMed 数据库中搜索了聚乙二醇干扰素（PegIFN）联合利巴韦林治疗 HCV 的相关文章，以及索非布韦联合治疗、simeprevir、达卡他韦/阿舒瑞韦、利托那韦增效的帕利瑞韦/奥比他韦/达沙布韦以及格拉替雷韦/艾尔巴韦的相关文章，包括普通人群和特殊人群。
PegIFN 联合利巴韦林仍然是一些患者的重要和相关选择，在基因 1 型感染中达到高达 79%的 SVR 率，在基因 2 或 3 感染中达到 89%，对于有利的 IL28B 基因型的患者，SVR 率会增加。DAA 联合 PegIFN/利巴韦林三联疗法在治疗难以治愈的 HCV 基因 3 型感染或存在耐药相关变异的患者中是有效的。由于在 HCV 管理方面具有悠久的历史，PegIFN alfa-2a 的疗效、耐受性和长期结果已在大规模研究和临床实践中得到证实，并已在许多人群中得到验证。此外，新出现的数据表明，与 DAA 相比，IFN 诱导的 SVR 与较低的肝细胞癌发生率相关。相反，新型 DAA 尚未在特殊人群中进行研究，长期结果，特别是肝硬化和/或肝细胞癌患者的肿瘤发展和复发，以及双重感染患者中 HBV 的再激活，仍然不清楚。
在这个无干扰素的时代，PegIFN 为基础的方案仍然是选择的 HCV 患者的安全有效的选择。
