中国丙型肝炎消除:泛基因型直接抗病毒药物时代特殊人群的诊疗挑战

HCV elimination in China:challenges in diagnosis and treatment of special populations in the era of pan-genotype direct-antiviral drugs

直接抗病毒药物在大部分丙型肝炎(丙肝)患者,包括很多既往难治患者中均可达到较高的治愈率,使得丙肝消除成为可能。我国丙肝高危人群患病率远高于一般人群,因此针对不同高危人群特点制定消除计划的微消除策略或为更加实际可行的方式。目前在我国,部分高危或特殊人群的丙肝筛查已在临床受到重视,如透析患者、孕期妇女、乙型肝炎患者或人类免疫缺陷病毒感染者,但仍有其他丙肝高危人群因分布零散、首诊于非感染科且接诊医护人员对丙肝认识不足、或者属于社会边缘群体等原因而无法被常规筛查体系所识别,成为丙肝消除的盲点及难点。本文意在探讨这类特殊人群诊疗面临的挑战,以期为公共卫生工作者和临床医师,特别是非感染/肝病科医师开展丙肝筛查及诊疗工作提供参考。

Direct-acting antivirals(DAAs)can achieve a high cure rates in most patients with hepatitis C,including many previously refractory patients,making it possible to eliminate hepatitis C.The prevalence of hepatitis C in high-risk populations is significantly higher than that in general population.Therefore,the micro elimination strategy of elimination of hepatitis C according to the characteristics of different high-risk groups may be a more practical and feasible way.Currently,the screening of HCV in some high-risk or special populations has been applied in China,such as dialysis patients,pregnant women,and patients with hepatitis B or human immunodeficiency virus infection.However,there are still other high-risk groups of hepatitis C that can’t be identified by the routine screening system due to their scattered distribution,the first diagnosis in the non-infectious department,the lack of understanding of hepatitis C by the medical staff,or belonging to the marginalized group,which have become the blind spots and difficulties in the elimination of hepatitis C.This article discusses the challenges in diagnosis and treatment of these special populations,in order to provide reference for public health workers and clinicians,especially doctors in non-infectious or hepatology departments to better carry out the screening,diagnosis and treatment of hepatitis C in China.