Coxeter-Smith Catherine, Gaglani Ria B, Ingram Robert D, Kidd Oliver T, Kumar Anjana S, Alhadad Amin, Alrubaiy Laith
Imperial College London, South Kensington, London, UK.
General Internal Medicine, Western General Hospital, Edinburgh, UK.
Transl Gastroenterol Hepatol. 2025 Jan 9;10:10. doi: 10.21037/tgh-24-87. eCollection 2025.
Hepatitis C virus (HCV), is a major health concern in the Middle East. Recent advances in direct-acting antivirals (DAAs) have transformed the treatment of HCV. The DAA chosen depends on the HCV genotype (GT) responsible for the infection, presence of cirrhosis, and prior treatment attempts. In addition, factors such as human immunodeficiency virus (HIV) co-infection and renal impairment can influence treatment. This literature review aims to discuss and appraise evidence on the efficacy and safety of the DAAs currently licensed for hepatitis C treatment in the Middle East.
Supporting publications from the National Institute for Health and Care Excellence (NICE) and European Association for the Study of the Liver guidelines were searched manually. A literature search of PubMed, MEDLINE, Cochrane Library, and EMBASE databases was performed with search terms including 'HCV', 'clinical trial', and the seven combinations of DAA combinations recommended by NICE. Papers from January 2016 to January 2021 were considered, along with seminal papers outside this range.
Of 390 publications found, 62 were included. In most studies, DAAs showed high efficacy in the recommended GTs, cirrhosis states, and prior HCV treatments. DAAs were found to be generally safe and well-tolerated: the most common side effects throughout were headache and nausea. Serious adverse events (SAEs) were seen when ribavirin and peginterferon alfa were taken in combination with the DAA.
This review demonstrates the strong evidence for the efficacy and safety of DAAs. The focus of HCV research should shift from efficacy of treatment to investigating accessible screening and diagnostics in order to achieve the World Health Organisation's (WHO's) goal of eradicating HCV by 2030.
丙型肝炎病毒（HCV）是中东地区主要的健康问题。直接作用抗病毒药物（DAA）的最新进展改变了HCV的治疗方式。所选用的DAA取决于导致感染的HCV基因型（GT）、肝硬化的存在情况以及既往治疗尝试。此外，人类免疫缺陷病毒（HIV）合并感染和肾功能损害等因素也会影响治疗。本综述旨在讨论和评估目前在中东地区获批用于丙型肝炎治疗的DAA的疗效和安全性证据。
手动检索了英国国家卫生与临床优化研究所（NICE）和欧洲肝脏研究协会指南的支持性出版物。使用包括“HCV”“临床试验”以及NICE推荐的DAA组合的七种组合等检索词，对PubMed、MEDLINE、Cochrane图书馆和EMBASE数据库进行了文献检索。纳入了2016年1月至2021年1月期间的论文，以及该范围之外的重要论文。
在找到的390篇出版物中，纳入了62篇。在大多数研究中，DAA在推荐的GT、肝硬化状态和既往HCV治疗中显示出高疗效。DAA总体上被发现是安全且耐受性良好的：最常见的副作用是头痛和恶心。当利巴韦林和聚乙二醇干扰素α与DAA联合使用时会出现严重不良事件（SAE）。
本综述证明了DAA疗效和安全性的有力证据。HCV研究的重点应从治疗疗效转向研究可及的筛查和诊断方法，以实现世界卫生组织（WHO）到2030年消除HCV的目标。
