Sandmann Lisa, Schulte Benjamin, Manns Michael P, Maasoumy Benjamin
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Visc Med. 2019 Jun;35(3):161-170. doi: 10.1159/000500963. Epub 2019 May 21.
Chronic hepatitis C virus (HCV) infection can lead to liver cirrhosis and its complications. Viral eradication is essential to prevent disease progression and reduces liver-related mortality and morbidity. Since the availability of direct-acting antivirals (DAA), HCV treatment has changed significantly. Current treatment strategies for different groups of patients as well as potential risks and caveats will be discussed in this review.
Interferon-free (IFN-free) treatment not only shortens treatment duration, but also achieves high rates of viral clearance and is overall well tolerated. Genotype-restricted but also pangenotypic combinations are available. Usually two DAA of different drug classes are combined. For the majority of the patients, treatment duration ranges from 8 to 12 weeks. Liver and kidney function as well as prior treatment experience and potential drug-drug interactions influence substance choices and treatment duration. However, modern IFN-free treatment is not only safer, but also overall far more simplified and effective. Global HCV eradication might be an ambitious but not completely unrealistic goal to pursue.
IFN-free antiviral treatment is safe and well tolerated. Patients can be treated almost independently of liver function or concomitant disease. Viral eradication is associated with reduced morbidity and mortality and better quality of life.
慢性丙型肝炎病毒（HCV）感染可导致肝硬化及其并发症。病毒清除对于预防疾病进展以及降低肝脏相关的死亡率和发病率至关重要。自从直接抗病毒药物（DAA）问世以来，HCV治疗发生了显著变化。本综述将讨论针对不同患者群体的当前治疗策略以及潜在风险和注意事项。
无干扰素（IFN-free）治疗不仅缩短了治疗疗程，还实现了高病毒清除率，并且总体耐受性良好。有基因型限制的以及泛基因型的联合方案可供选择。通常将两种不同药物类别的DAA联合使用。对于大多数患者，治疗疗程为8至12周。肝脏和肾脏功能以及既往治疗经验和潜在的药物相互作用会影响药物选择和治疗疗程。然而，现代的无干扰素治疗不仅更安全，而且总体上更加简化且有效。全球消除HCV可能是一个雄心勃勃但并非完全不切实际的目标。
无干扰素抗病毒治疗安全且耐受性良好。患者几乎可以独立于肝功能或伴随疾病进行治疗。病毒清除与发病率和死亡率降低以及生活质量改善相关。
