摘要
2016年澳大利亚胃肠病学会等多家机构组织专家联合撰写并发布了《2016年澳大利亚丙型肝炎病毒(HCV)感染诊治指南》,内容涉及澳大利亚HCV感染的流行现状及管理模式、丙型肝炎病毒感染的筛查及诊断、治疗前评估、治疗方案选择、治疗期间监测及治疗后随访等。本研究对其中丙型肝炎病毒的规范化抗病毒治疗进行解读,并着重与《2015年中国丙型肝炎防治指南》《2016年欧洲肝病学会丙型肝炎治疗指南》《2015年加拿大肝病学会慢性丙型肝炎管理共识指南》《2015及2016年美国肝病学会丙型肝炎治疗指南》《2016年英国HCV感染诊治指南》以及《2016年世界卫生组织丙型肝炎治疗指南》中的相应内容进行比较,以期为临床肝病医生了解各个指南推荐意见的异同、规范HCV感染的临床诊治提供便利。
Hepatitis C virus(HCV)infection is a common health problem worldwide and it is estimated that approximately 110 million people(or 1.7%of world population)are infected with HCV but most of them are unaware of their infection.The reported prevalence rate for chronic HCV infection in China was 0.43%(being close to 10 million people).HCV infection is a well-recognized risk factor for chronic liver diseases and will likely evolve into end stage liver diseases(ESLDs)such as cirrhosis,hepatocellular carcinoma(HCC)and liver failure if left untreated.In certain western countries such as Australia,HCV-related ESLDs are among themost common indications of liver transplantation.As prevention of HCV infection through vaccination is not yet available,proper management for HCV infection is of paramount importance in preventing the development of HCV-related liver diseases in the infected individuals.The advent of direct-acting antiviral(DAA)agents has revolutionized the treatment approaches for HCV infection.Compared to the conventional pegylated interferonαand ribavirin(PegIFN/RBV)-based treatment regimens which often have limited efficacy with poor tolerability,DAAs are more effective in achieving sustained virological response(SVR)and are much better-tolerated.Studies have also shown DAAs are superior to the conventional treatments in reversing liver fibrosis,regressing liver cirrhosis,and reducing the risk of HCC development.However,the high cost of DAAs may limit these agents from being widely used in all HCV infected individuals in all geographic regions.In China's Mainland,DAAs are currently unavailable and will likely remain unavailable for many years to come.As such,combination of the interferon-and ribavirin-based regimens remains the mainstream therapy for HCV-infected individuals in China as recommended by the most recent Chinese consensus statement for the management of HCV infection(2015 edition).In contrast,the newly released Australian consensus for the management of HCV infection recommends DAAs be used in all HCV infected people in all communities through the Pharmaceutical Benefits Scheme(PBS).Notably,the currently available guidelines for the management of HCV infection from different countries/organizations may vary in several aspects possibly reflecting the underlying variations of HCV genotype distribution,epidemiological features,and the availability of reliable medical social welfare systems.This article aims to compare the recently released Australian consensus for the management of HCV infection to the guidelines of China and several other countries/organizations in order to bring to the readers important considerations in the management of HCV patients.In the first part of the series,various guidelines for the screening,diagnosis,and pre-treatment assessment for the HCV infected individuals are compared.
作者
刘姝
王炳元
乔梁
张海燕
Liu Shu;Wang Bing-yuan;Qiao Liang;Zhang Hai-yan(Geriatric Comprehensive Ward,The First Affiliated Hospital of China Medical University,Shenyang 110001,China;Storr Liver Centre,Westmead Institute for Medical Research,University of Sydney,Westmead,NSW 2145,Australia;Department of Geriatric Gastroenterology,The First Affiliated Hospital of China Medical University,Shenyang 110001,China)
出处
《兰州大学学报（医学版）》
CAS
2018年第6期62-69,共8页
Journal of Lanzhou University（Medical Sciences）
关键词
病毒性肝炎
丙型肝炎病毒
指南
共识
治疗方案选择
治疗期间监测
治疗后随访
对比解读
viral hepatitis
hepatitis C virus
guideline
consensus
treatment options
monitoring during treatment
follow up after treatment
comparison
