The Kirby Institute, UNSW Sydney, Sydney, Australia.
National Reference Center for Viral Hepatitis B, C and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; INSERM U955, Créteil, France.
J Hepatol. 2018 Nov;69(5):1188-1196. doi: 10.1016/j.jhep.2018.06.016. Epub 2018 Jun 28.
Of ∼10.2 million people with chronic HCV infection in Europe, 6.7 million live in Eastern Europe, 2.3 million in Western Europe and 1.2 million in Central Europe. HCV transmission continues to occur in parallel with an increasing HCV-related liver disease burden, the result of an ageing population infected during peak HCV epidemics decades earlier. In 2016, the World Health Organization set targets to eliminate HCV infection as a major public health threat by 2030. Across Europe, an estimated 36% of those living with chronic HCV infection have been diagnosed and ∼5% have been treated. A major barrier to enhancing HCV treatment uptake has been restrictions set by payers, including national governments and others, in response to the initially high list prices of direct-acting antiviral (DAA) therapies. The aims of this article are to discuss DAA restrictions in Europe, why DAA restrictions are still in place, what has facilitated the removal of DAA restrictions, and what challenges remain as we attempt to eliminate HCV as a major public health threat in the region by 2030.
在欧洲，约有 1020 万慢性 HCV 感染患者，其中 670 万生活在东欧，230 万生活在西欧，120 万生活在中欧。HCV 的传播仍在继续，与此同时，由于几十年前 HCV 流行高峰期感染的人口老龄化，与 HCV 相关的肝病负担也在不断增加。2016 年，世界卫生组织（WHO）设定了到 2030 年消除 HCV 感染这一主要公共卫生威胁的目标。在整个欧洲，据估计，约有 36%的慢性 HCV 感染患者已被诊断出来，约 5%的患者已接受治疗。阻碍 HCV 治疗普及率提高的一个主要障碍是支付方（包括各国政府和其他方）为应对直接作用抗病毒（DAA）疗法最初的高昂标价而设置的限制。本文旨在讨论欧洲的 DAA 限制，为什么 DAA 限制仍然存在，是什么促进了 DAA 限制的取消，以及在我们试图到 2030 年消除 HCV 这一主要公共卫生威胁的过程中，仍存在哪些挑战。
