Thomas H C, Booth J, Brown J
Academic Department of Medicine, Imperial College School of Medicine, St Mary's Hospital, London, England.
Drugs. 1996;52 Suppl 2:1-7; discussion 7-8. doi: 10.2165/00003495-199600522-00003.
Hepatitis C virus (HCV) infection is associated with a variable disease course and response to therapy. Some infected patients may develop little or no disease for 30 to 40 years, whereas others will develop cirrhosis within 5 to 10 years. Both host and viral factors influence the rate of disease progression. The management of patients is determined by the severity of their disease assessed by liver biopsy. Those with mild hepatitis without fibrosis do not require treatment but should undergo liver biopsy every 3 years. Patients with mild hepatitis with fibrosis, or with moderate or severe hepatitis with or without fibrosis, should be offered treatment. Interferon-alpha (IFN alpha) is currently the only licensed treatment for HCV infection. Although initial response rates to IFN alpha are high, over half the patients relapse and a sustained response is achieved in only 10 to 35% of patients. Higher doses of IFN alpha and a longer treatment duration are associated with better response rates. Treatment options for those who fail to respond to IFN alpha include a second course of IFN alpha at a higher dose or IFN alpha in combination with ribavirin, phlebotomy or ursodeoxycholic acid. At present, however, there are insufficient data to routinely recommend any of these options.
丙型肝炎病毒（HCV）感染与疾病进程的多变性以及对治疗的反应相关。一些受感染患者在30至40年内可能几乎不发病或仅有轻微症状，而另一些患者则会在5至10年内发展为肝硬化。宿主和病毒因素都会影响疾病进展速度。患者的治疗方案取决于通过肝活检评估的疾病严重程度。轻度肝炎且无纤维化的患者无需治疗，但应每3年进行一次肝活检。轻度肝炎伴有纤维化，或中度或重度肝炎伴有或不伴有纤维化的患者，应接受治疗。α干扰素（IFNα）是目前唯一获许可用于治疗HCV感染的药物。尽管对IFNα的初始反应率较高，但超过半数的患者会复发，只有10%至35%的患者能实现持续反应。更高剂量的IFNα和更长的治疗疗程与更好的反应率相关。对IFNα治疗无反应的患者可选择的治疗方案包括更高剂量的IFNα第二疗程，或IFNα与利巴韦林、放血疗法或熊去氧胆酸联合使用。然而，目前尚无足够数据可常规推荐这些方案中的任何一种。
