慢性丙型肝炎病毒感染通常无症状。这些患者在诊断时肝脏病变的严重程度各不相同,从组织病理学的角度来看,大多数患有轻度疾病。已经描述了一系列与轻度纤维化患者纤维化进展相关的因素:诊断年龄,感染的持续时间,男性,艾滋病毒合并感染,随访期间转氨酶水平,酒精消费,代谢因素,如糖尿病和超重,在最初的活检坏死的炎症活动,和脂肪变性的程度。在基因型1型丙型肝炎感染的患者中,标准治疗是聚乙二醇干扰素和利巴韦林。然而,伴随使用第一代蛋白酶抑制剂,反应率显着增加,boceprevir或telaprevir。在中度纤维化患者中,这些药物耐受性良好,除了有效。目前,对于基线反应预测因子和/或使用telaprevir或boceprevir治疗禁忌症的患者,应保留双重治疗.在基因型1以外的基因型患者中,标准治疗仍然是聚乙二醇干扰素和利巴韦林的组合,尽管新的直接作用抗病毒药物如索非布韦和simeprevir的开发将改变这些患者使用的策略.等待新疗法的决定很复杂,因为它们的发布日期未知;同样,它们的高成本将限制其使用的可能性。
Chronic hepatitis C virus infection is usually asymptomatic. The severity of the hepatic lesion in these patients at diagnosis varies and, from the histopathologic point of view, most have mild disease. A series of factors have been described that correlate with the progression of fibrosis in patients with mild fibrosis: age at diagnosis, the duration of the infection, male sex, HIV coinfection, transaminase levels during follow-up, alcohol consumption, metabolic factors such as diabetes and overweight, necroinflammatory activity in the initial biopsy, and the degree of steatosis. In patients with genotype 1 hepatitis C infection, the standard treatment has been pegylated interferon and ribavirin. However, response rates are markedly increased by concomitant use of first-generation protease inhibitors, boceprevir or telaprevir. In patients with moderate fibrosis, these drugs are well tolerated, in addition to being effective. Currently, dual therapy should be reserved for patients with good baseline predictive factors of response and/or contraindications for treatment with telaprevir or boceprevir. In patients with genotypes other than genotype 1, the standard treatment continues to be the combination of pegylated interferon and ribavirin, although the development of new direct-acting antiviral agents such as sofosbuvir and simeprevir will change the strategies used in these patients. The decision to wait for the new treatments is complex because their release date is unknown; likewise, their high cost will limit the possibilities for their use.