Salmon D, Mondelli M U, Maticic M, Arends J E
Division of Infectious Diseases and Immunology, Center for Diagnosis, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France.
Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
J Viral Hepat. 2018 Apr;25(4):320-328. doi: 10.1111/jvh.12823. Epub 2018 Feb 19.
To examine mid-term benefits on hepatic complications, extrahepatic clinical syndromes and quality of life associated with HCV cure; to review the few safety issues linked to oral direct-acting antivirals (DAAs); and to discuss the potential population benefits of reducing the burden of HCV infection. DAAs cure HCV infection in more than 95% of patients. The halting of liver inflammation and fibrosis progression translates into both hepatic and extrahepatic benefits and reduces the need for liver transplantation. A reduction in the frequency of extrahepatic manifestations such as mixed cryoglobulinaemia and vasculitis and improvements in quality of life and fatigue have also been described. A few safety issues linked to DAAs such as the potential recurrence of aggressive HCC, the flares of hepatitis B virus in patients with overt or occult HBV infection are been discussed. Curing HCV infection also has a high potential to reduce the burden of HCV infection at the population level. With widespread scaling up of HCV treatment, several modeling studies suggest that major reductions in HCV prevalence and incidence are possible, and that elimination of viral hepatitis is an achievable target by 2030.
研究丙型肝炎病毒治愈对肝脏并发症、肝外临床综合征及生活质量的中期益处；回顾与口服直接抗病毒药物（DAAs）相关的少数安全问题；并讨论减轻丙型肝炎病毒感染负担对人群的潜在益处。DAAs可使超过95%的患者治愈丙型肝炎病毒感染。肝脏炎症和纤维化进展的停止带来了肝脏和肝外两方面的益处，并减少了肝移植的需求。也有报道称，肝外表现如混合性冷球蛋白血症和血管炎的发生频率降低，生活质量和疲劳症状有所改善。文中讨论了与DAAs相关的一些安全问题，如侵袭性肝癌的潜在复发、显性或隐匿性乙型肝炎病毒感染患者的乙型肝炎病毒再激活。治愈丙型肝炎病毒感染在人群层面也极有可能减轻丙型肝炎病毒感染的负担。随着丙型肝炎治疗的广泛推广，多项模型研究表明，丙型肝炎病毒的流行率和发病率有可能大幅降低，到2030年消除病毒性肝炎是一个可以实现的目标。
