Department of Internal Medicine 1, Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany.
Pharmacol Ther. 2018 Mar;183:118-126. doi: 10.1016/j.pharmthera.2017.10.009. Epub 2017 Oct 10.
Hepatitis C virus (HCV) is a global health problem, because infection frequently leads to chronic hepatitis C eventually progressing to liver cirrhosis and liver cancer. Improved insights into the HCV replication cycle and the role of HCV non-structural proteins have recently enabled to identify drugs directly acting on specific HCV target structures. Agents from three drug classes have been developed and approved by the health authorities. Combinations of two or more drugs from different classes achieve high (>90%) HCV clearance rates and are well tolerated. This interferon-free DAA (direct antiviral agent) therapy has revolutionized antiviral therapy in hepatitis C so that successful hepatitis C treatment can be offered to virtually all patients irrespective of their co-morbidity. This review provides an overview over currently approved regimens and outlines their use in clinical practice. In addition potential short-comings of the current therapeutic options such as drug-drug interactions and selection of viral resistance are addressed. DAA combination therapy has the potential to obtain global control over hepatitis C. However, easy access to DAAs, availability of reliable HCV diagnostics, and affordable costs remain still important goals, which must be reached to globally eliminate hepatitis C.
丙型肝炎病毒（HCV）是一个全球性的健康问题，因为感染常常导致慢性丙型肝炎，最终进展为肝硬化和肝癌。最近，对 HCV 复制周期和 HCV 非结构蛋白作用的深入了解，使得能够识别直接针对特定 HCV 靶结构的药物。来自三个药物类别的药物已经被卫生当局开发和批准。两种或更多种来自不同类别的药物的组合可实现高（>90%）的 HCV 清除率，并且具有良好的耐受性。这种无干扰素的 DAA（直接抗病毒药物）治疗方法彻底改变了丙型肝炎的抗病毒治疗，以至于几乎所有患者，无论其合并症如何，都可以接受成功的丙型肝炎治疗。这篇综述概述了目前批准的方案，并概述了它们在临床实践中的应用。此外，还讨论了当前治疗方案的潜在缺点，如药物相互作用和病毒耐药性的选择。DAA 联合治疗有可能在全球范围内控制丙型肝炎。然而，容易获得 DAA、可靠的 HCV 诊断以及可负担的成本仍然是重要的目标，必须实现这些目标才能在全球范围内消除丙型肝炎。
