Zusammenfassung
Die Standardtherapiedauer für Patienten mit chronischer Hepatitis C beträgt 48 (HCV-1) bzw. 24 Wochen (HCV-2/3). Unter zusätzlicher Berücksichtigung der Ausgangsviruslast, des initialen virologischen Ansprechens und des Fibrosestadiums erscheint eine weitere Individualisierung möglich. Nichtzirrhotische Patienten mit einer HCV-1-Infektion, einer Viruslast vor Therapiebeginn von unter 600.000 U/ml und einem raschen virologischen Ansprechen (HCV-RNA < 50 U/ml zu Woche 4) erreichen mit einer 24-wöchigen Therapie dauerhafte virologische Ansprechraten von fast 90%. HCV-2- und HCV-3-infizierte Patienten mit niedriger Viruslast zu Therapiebeginn und nicht nachweisbarer HCV-RNA zu Woche 4 können für weniger als 24 Wochen behandelt werden, ohne die dauerhaften virologischen Ansprechraten zu verringern. Eine Verlängerung der Therapiedauer auf 72 Wochen scheint hingegen für HCV-1-infizierte Patienten von Vorteil zu sein, die nach 12 Wochen Therapie noch eine Viruslast von 50–6000 IU/ml im Serum nachweisbar haben.
Abstract
Patients infected with HCV genotype 1 are treated with a pegylated interferon plus ribavirin for 48 weeks, while HCV-2 or 3 infected patients are treated for 24 weeks. Knowledge of the HCV genotype and fibrosis stage together with baseline viremia and the initial virologic response to therapy enables further individualization of the treatment duration. Non-cirrhotic patients with HCV-1 infection, a baseline viremia < 600,000 U/ml and a rapid virologic response (< 50 U/ml at week 4) can achieve a sustained virologic response rate of almost 90% with only 24 weeks of combination therapy. HCV-2 and HCV-3 infected patients with low baseline viremia can be treated for less than 24 weeks without compromising sustained virologic response rates. A longer treatment duration of up to 72 weeks appears reasonable for HCV-1 infected patients with serum HCV RNA levels of 50–6,000 U/ml at week 12 of therapy.
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Zeuzem, S. Individualisierte Behandlung der chronischen Hepatitis C. Internist 47 (Suppl 1), S20–S25 (2006). https://doi.org/10.1007/s00108-006-1620-0
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DOI: https://doi.org/10.1007/s00108-006-1620-0