丙型肝炎。

Hepatitis C.

机构信息

Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Liver Unit, Kings College Hospital, London, UK; Division of Medicine, University College London Medical School, London, UK.

出版信息

Lancet. 2019 Oct 19;394(10207):1451-1466. doi: 10.1016/S0140-6736(19)32320-7.

Abstract

Hepatitis C is a global health problem, and an estimated 71·1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23·7 cases per 100 000 population (95% uncertainty interval 21·3-28·7) in 2015, with an estimated 1·75 million new HCV infections diagnosed in 2015. Globally, the most common infections are with HCV genotypes 1 (44% of cases), 3 (25% of cases), and 4 (15% of cases). HCV transmission is most commonly associated with direct percutaneous exposure to blood, via blood transfusions, health-care-related injections, and injecting drug use. Key high-risk populations include people who inject drugs, men who have sex with men, and prisoners. Approximately 10-20% of individuals who are chronically infected with HCV develop complications, such as cirrhosis, liver failure, and hepatocellular carcinoma over a period of 20-30 years. Direct-acting antiviral therapy is now curative, but it is estimated that only 20% of individuals with hepatitis C know their diagnosis, and only 15% of those with known hepatitis C have been treated. Increased diagnosis and linkage to care through universal access to affordable point-of-care diagnostics and pangenotypic direct-acting antiviral therapy is essential to achieve the WHO 2030 elimination targets.

摘要

丙型肝炎是一个全球性的健康问题,据估计有 7110 万人患有慢性丙型肝炎病毒(HCV)感染。2015 年全球丙型肝炎发病率为每 10 万人 23.7 例(95%不确定区间为 21.3-28.7),估计 2015 年诊断出 175 万例新丙型肝炎感染病例。在全球范围内,最常见的感染是 HCV 基因型 1(44%的病例)、3(25%的病例)和 4(15%的病例)。HCV 传播最常与直接经皮接触血液有关,通过输血、卫生保健相关注射和注射吸毒。关键的高危人群包括吸毒者、男男性行为者和囚犯。大约 10-20%的慢性 HCV 感染者在 20-30 年内会发展为并发症,如肝硬化、肝功能衰竭和肝细胞癌。直接作用抗病毒疗法现在是可治愈的,但据估计,只有 20%的丙型肝炎患者知道自己的诊断,只有 15%的已知丙型肝炎患者接受了治疗。通过普及负担得起的即时检测诊断和泛基因型直接作用抗病毒疗法,增加诊断和获得治疗,对于实现世卫组织 2030 年消除目标至关重要。

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