Sharara A I
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
South Med J. 1997 Sep;90(9):872-7. doi: 10.1097/00007611-199709000-00002.
Infection with the hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide. Epidemiologic and natural history studies have helped to define the clinical impact of HCV infection, and molecular diagnostic assays have established clinical endpoints against which therapeutic regimens are currently tested. The absence of definitive therapy has generated controversy regarding indications and optimal candidacy for currently approved treatment. This paper reviews the epidemiology, natural history, clinical manifestations, diagnostic modalities, and current treatment of chronic HCV infection.
Search of the MEDLINE database for English-language articles and abstracts on chronic HCV infection yielded data from more than 500 original papers, reviews, and abstracts.
Hepatitis C virus is transmitted primarily through contaminated blood and less effectively by human body secretions, but a large proportion of patients have no clearly identifiable parenteral risk factors for viral acquisition. Infection with HCV results in subclinical chronic hepatitis in the majority of patients and may progress, usually over decades, to cirrhosis and hepatocellular carcinoma. Extrahepatic manifestations of HCV infection include porphyria cutanea tarda, mixed essential cryoglobulinemia, and membranoproliferative glomerulonephritis. Diagnostic modalities are accurate in estimating viral load and genotype and may be helpful in predicting and assessing response to treatment. Current therapy is limited to interferon alfa and is effective at viral eradication in only a small number of patients. The adjuvant use of drugs, such as ribavirin, in combination with interferon may hold promise at enhancing viral eradication. Understanding the mechanisms behind viral persistence and immune escape of HCV will be essential in developing effective future therapeutic and preventive strategies.
丙型肝炎病毒（HCV）感染是全球慢性肝病的主要病因。流行病学和自然史研究有助于明确HCV感染的临床影响，分子诊断检测已确立了当前用于测试治疗方案的临床终点。缺乏确定性治疗方法引发了关于当前已批准治疗的适应症和最佳候选对象的争议。本文综述了慢性HCV感染的流行病学、自然史、临床表现、诊断方法及当前治疗情况。
检索MEDLINE数据库中关于慢性HCV感染的英文文章和摘要，得到了来自500多篇原始论文、综述和摘要的数据。
丙型肝炎病毒主要通过受污染血液传播，通过人体分泌物传播的效率较低，但很大一部分患者没有明确可识别的病毒感染肠外危险因素。大多数患者感染HCV后会出现亚临床慢性肝炎，通常在几十年内可能进展为肝硬化和肝细胞癌。HCV感染的肝外表现包括迟发性皮肤卟啉症、混合性冷球蛋白血症和膜增生性肾小球肾炎。诊断方法在估计病毒载量和基因型方面准确，可能有助于预测和评估治疗反应。当前治疗仅限于干扰素α，仅在少数患者中能有效根除病毒。利巴韦林等药物与干扰素联合使用可能有望提高病毒根除率。了解HCV病毒持续存在和免疫逃逸背后的机制对于制定未来有效的治疗和预防策略至关重要。
