Faculty of Medicine, Thammasat University, Bangkok, Thailand.
Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
Aliment Pharmacol Ther. 2019 Mar;49(5):492-505. doi: 10.1111/apt.15100. Epub 2019 Jan 27.
Hepatitis C virus (HCV) genotype 6 (GT6) is predominantly encountered in Southeast Asia and data on GT6 response to direct-acting antiviral (DAA) therapy are relatively limited.
To review the epidemiology and virologic outcome of DAA regimens in HCV GT6 patients.
Electronic literature search of PubMed, EMBASE, and The Cochrane Library databases were conducted.
Hepatitis C virus genotype 6 is the most genetically diverse, has a prevalence of 19.9%-95.6% in HCV infected patients in Southeast Asia and has been associated with a higher risk of HCC in those with cirrhosis. After an extensive literature review, a total of 20 studies were selected to assess study population and treatment outcomes (total of 938 GT6 patients were included); 12 were clinical trials and eight were observational studies. Sustained virologic response at week 12 (SVR 12) following glecaprevir/pibrentasvir (n = 4; 108 patients), ledipasvir/sofosbuvir (n = 8; 427 patients), sofosbuvir/velpatasvir with or without voxilaprevir (n = 5; 171 patients), sofosbuvir/daclatasvir (n = 3; 172 patients) and sofosbuvir with ribavirin (n = 3; 60 patients) was 98%-100%, 64%-100%, 100%, 88%-94% and 100%, respectively. Failure was mostly in those with cirrhosis and prior treatment experience. DAA therapy was well tolerated and with a serious adverse event rate of <5%.
Hepatitis C virus genotype 6 is genetically diverse and is highly prevalent in Asia. While SVR rates have been high, cirrhosis and prior treatment experience marginally compromise response to DAAs. Large scale and exclusive studies in HCV genotype 6 prevalent areas are needed, while the current evidence suggests that DAAs are highly effective and safe.
丙型肝炎病毒（HCV）基因型 6（GT6）主要见于东南亚，关于 GT6 对直接作用抗病毒（DAA）治疗的反应的数据相对有限。
综述 HCV GT6 患者 DAA 方案的流行病学和病毒学结果。
对 PubMed、EMBASE 和 The Cochrane Library 数据库进行电子文献检索。
HCV 基因型 6 是遗传多样性最高的一种，在东南亚 HCV 感染患者中的流行率为 19.9%-95.6%，与肝硬化患者中 HCC 的风险增加相关。经过广泛的文献回顾，共选择了 20 项研究来评估研究人群和治疗结果（共纳入 938 例 GT6 患者）；其中 12 项为临床试验，8 项为观察性研究。格拉帕雷维/哌仑他韦（n=4；108 例）、来迪派韦/索磷布韦（n=8；427 例）、索磷布韦/维帕他韦联合或不联合 voxilaprevir（n=5；171 例）、索磷布韦/达卡他韦（n=3；172 例）和索磷布韦联合利巴韦林（n=3；60 例）治疗后第 12 周的持续病毒学应答（SVR12）率分别为 98%-100%、64%-100%、100%、88%-94%和 100%。失败主要发生在肝硬化和有既往治疗史的患者中。DAA 治疗耐受性良好，严重不良事件发生率<5%。
HCV 基因型 6 遗传多样性高，在亚洲高度流行。虽然 SVR 率较高，但肝硬化和既往治疗经验会略微影响 DAA 的反应。需要在 HCV 基因型 6 流行地区进行大规模的、专门的研究，而目前的证据表明 DAA 非常有效且安全。
