慢性C型肝炎之全口服小分子藥物治療

Direct -Acting Antiviral Agents for Chronic Hepatitis C

C型肝炎是全球主要的肝臟疾病。臺灣C肝抗體陽性盛行率在一般人口約2％～5％，病毒基因型分佈以1b型最多，2a型次之。C型肝炎仍無疫苗可供預防，長效型聚乙二醇干擾素合併口服抗病毒藥物雷巴威林24或48週曾經是C型肝炎之標準治療，雖有不錯療效但有禁忌症及顯著副作用。近來全口服小分子藥物與干擾素／雷巴威林合併，甚至免除干擾素，對難治的第一型病患接受8至24週不等療程的治療有90％以上的持久病毒學反應。本文將回顧C型肝炎病毒學、流行病學、致病機轉與抗病毒藥物作用機制，介紹全口服小分子藥物及當前國内外主流肝病醫學會對C型肝炎治療的建議。

Chronic hepatitis C (CHC) is one of the major liver diseases worldwide. The prevalence of antibodies to hepatitis C virus (anti-HCV) is 2-5% in the general population in Taiwan, with HCV genotype 1b and 2a as the most common subtypes. HCV vaccine is not yet available and pegylated interferon alfa plus ribavirin (PR) for 24 to 48 weeks had been the standard of care for CHC with good effectiveness. However, the ineligibility and substantial adverse effects prevent many patients from PR therapy. The recent introduction of direct acting antivirals (DAA) in combination with PR or interferon-free DAA for 8-24 weeks bears the sustained virologic response (SVR) rate of > 90%. In this article, the virology, epidemiology, pathogenesis of HCV infection and modes of action for DAA regimens will be reviewed. In addition, the treatment recommendations for CHC in several professional societies will be introduced.