丙型肝炎直接抗病毒治疗耐药相关突变的临床意义

Clinical significance of drug resistance-associated mutations in treatment of hepatitis C with direct-acting antiviral agents

直接抗病毒药物（DAAs）治疗慢性丙型肝炎病毒感染获得了较高的持续病毒学应答率。但耐药相关突变（RAVs）在其治疗失败中有着重要作用，引起越来越多的临床关注。现从DAAs耐药相关突变的定义，RAVs与基因型的关系，已知耐药突变及其流行率，RAVs对于初治及经治患者的影响，以及耐药检测的临床作用方面阐述RAVs的临床意义，以期对优化临床DAAs治疗方案提供借鉴，获得更高的持续病毒学应答率。

Direct-acting antiviral agents （DAAs） achieve a high sustained virologic response rate in the treatment of chronic hepatitis C virus infection. However, drug resistance-associated mutations play an important role in treatment failure and have attracted more and more attention. This article elaborates on the clinical significance of drug resistance-associated mutations from the aspects of their definition, association with genotype, known drug resistance-associated mutations and their prevalence rates, the impact of drug resistance-associated mutations on treatment naive and treatment-experienced patients, and the role of clinical detection, in order to provide a reference for clinical regimens with DAAs and help to achieve higher sustained virologic response rates.