Laboratoire de Virologie,Institut de Biologie et Pathologie, CHU Grenoble-Alpes,Grenoble,France.
Laboratoire de Virologie, CHU de Rennes,Rennes,France.
Epidemiol Infect. 2019 Jan;147:e234. doi: 10.1017/S0950268819001225.
Treatment options for Hepatitis C infection have greatly improved with direct-acting antiviral (DAA) combinations achieving high cure rates. Nevertheless, the cost of this treatment is still high and access to treatment in many countries has been preferentially reserved for patients with more severe fibrosis (F3 and F4). In this French nationwide study, we investigated the epidemiological characteristics and genotype distribution of hepatitis C virus (HCV) in treatment-naive patients with METAVIR fibrosis stages between F0 and F2 in order to identify patient profiles that became eligible for unrestricted treatment in a second period. Between 2015 and 2016 we collected data from nine French university hospitals on a total of 584 HCV positive patients with absent, mild or moderate liver fibrosis. The most represented genotypes were genotype 1b (159/584; 27.2%), followed by genotype 1a (150/584; 25.7%); genotype 3 (87/584: 14.9%); genotype 4 (80/584; 13.7%). Among genotype 4: 4a was predominantly encountered with 22 patients (27.5% of genotype 4). Genotypes 1b and 1a are currently the most frequent virus types present in treatment-naive patients with mild fibrosis in France. They can be readily cured using the available DAA. Nevertheless, non-a/non-d genotype 4 is also frequent in this population and clinical data on the efficacy of DAA on these subtypes is missing. The GEMHEP is the French group for study and evaluation of viral hepatitis on a national scale. Data collection on epidemiological and molecular aspects of viral hepatitis is performed on a regular basis in all main French teaching hospitals and serves as a basis for surveillance of these infections. Analysis and trends are regularly published on behalf of the GEMHEP group. Data collection was performed retrospectively over the 2015-2016 period, covering nine main university hospitals in France. A total of 584 hepatitis C positive patients were included in this study. Genotyping of the circulating viruses showed a high prevalence of genotypes 1b and 1a in our population. The epidemiology of hepatitis C is slowly changing in France, particularly as a consequence of the rise of 'non-a non-d' genotype 4 viruses mainly originating from African populations. More data concerning treatment efficacy of these genotypes is needed in order to guide clinical care.
直接作用抗病毒 (DAA) 联合治疗方案大大改善了丙型肝炎感染的治疗选择，治愈率很高。然而，这种治疗的成本仍然很高，在许多国家，治疗机会优先保留给纤维化程度更严重的患者（F3 和 F4）。在这项法国全国性研究中，我们研究了 METAVIR 纤维化分期为 F0 至 F2 的初治患者中丙型肝炎病毒 (HCV) 的流行病学特征和基因型分布，以确定在第二阶段可以不受限制地接受治疗的患者特征。2015 年至 2016 年期间，我们从法国九所大学医院收集了总共 584 名 HCV 阳性、无明显肝纤维化、轻度或中度肝纤维化患者的数据。最常见的基因型是基因型 1b（159/584；27.2%），其次是基因型 1a（150/584；25.7%）；基因型 3（87/584：14.9%）；基因型 4（80/584；13.7%）。基因型 4 中，4a 型占主导地位，有 22 例（基因型 4 的 27.5%）。基因型 1b 和 1a 目前是法国轻度纤维化初治患者中最常见的病毒类型。它们可以通过现有的 DAA 很容易地治愈。然而，非-a/非-d 基因型 4 在该人群中也很常见，并且缺乏关于这些亚型 DAA 疗效的临床数据。GEMHEP 是法国在全国范围内研究和评估病毒性肝炎的组织。所有主要法国教学医院都定期进行病毒性肝炎的流行病学和分子方面的数据收集，作为这些感染监测的基础。代表 GEMHEP 小组定期发布分析和趋势。数据收集是在 2015-2016 年期间进行的回顾性研究，覆盖了法国的九所主要大学医院。本研究共纳入 584 名丙型肝炎阳性患者。循环病毒的基因分型显示，我们的人群中基因型 1b 和 1a 的流行率很高。法国的丙型肝炎流行病学正在缓慢变化，特别是由于主要来自非洲人群的“非-a 非-d”基因型 4 病毒的增加。需要更多关于这些基因型治疗效果的数据，以指导临床护理。
