Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
J Gastroenterol. 2018 May;53(5):591-605. doi: 10.1007/s00535-017-1427-x. Epub 2018 Jan 3.
Hepatitis C virus (HCV) infection is one of the primary causes of liver cirrhosis and hepatocellular carcinoma. In hemodialysis patients, the rate of HCV infection is high and is moreover associated with a poor prognosis. In liver transplantation patients with HCV infection, recurrent HCV infection is universal, and re-infected HCV causes rapid progression of liver fibrosis and graft loss. Additionally, in patients with HCV and human immunodeficiency virus (HIV) co-infection, liver fibrosis progresses rapidly. Thus, there is an acute need for prompt treatment of HCV infection in these special populations (i.e., hemodialysis, liver transplantation, HIV co-infection). However, until recently, the standard anti-HCV treatment involved the use of interferon-based therapy. In these special populations, interferon-based therapies could not achieve a high rate of sustained viral response and moreover were associated with a higher rate of adverse events. With the development of novel direct-acting antivirals (DAAs), the landscape of anti-HCV therapy for special populations has changed dramatically. Indeed, in special populations treated with interferon-free DAAs, the sustained viral response rate was above 90%, with a lower incidence and severity of adverse events.
丙型肝炎病毒（HCV）感染是导致肝硬化和肝细胞癌的主要原因之一。在血液透析患者中，HCV 感染率较高，且预后较差。在 HCV 感染的肝移植患者中，HCV 复发普遍存在，再感染的 HCV 可导致肝纤维化迅速进展和移植物丢失。此外，在 HCV 和人类免疫缺陷病毒（HIV）合并感染的患者中，肝纤维化迅速进展。因此，这些特殊人群（即血液透析、肝移植、HIV 合并感染）迫切需要及时治疗 HCV 感染。然而，直到最近，标准的抗 HCV 治疗还包括使用干扰素为基础的治疗。在这些特殊人群中，基于干扰素的治疗无法实现高持续病毒应答率，且不良反应发生率更高。随着新型直接作用抗病毒药物（DAAs）的发展，特殊人群抗 HCV 治疗的格局发生了巨大变化。实际上，在接受无干扰素 DAA 治疗的特殊人群中，持续病毒应答率超过 90%，不良反应的发生率和严重程度较低。
