Response to standard of care antiviral treatment in patients with HCV liver cirrhosis
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关于非典的英语作文素材Title: Understanding the SARS Outbreak: A Historical Perspective。
In 2002, a novel coronavirus emerged in Guangdong Province, China, sparking a global health crisis known as Severe Acute Respiratory Syndrome (SARS). This outbreak not only affected China but also spread to other countries, causing widespread fear and concern. Understanding the SARS outbreak is crucial for comprehending the dynamics of infectious diseases and the measures necessary to combat them.Firstly, it's essential to grasp the origins of the SARS virus. SARS-CoV, the virus responsible for SARS, is believed to have originated in bats and then transmitted to humans, possibly through intermediary hosts such as civet cats in live animal markets. The virus primarily spreads through respiratory droplets, making it highly contagious, especially in crowded and poorly ventilated environments.The rapid spread of SARS highlighted the interconnectedness of the modern world and the importance of global cooperation in combating infectious diseases. International travel facilitated the rapid transmission of the virus across borders, underscoring the need for robust public health measures and information sharing among nations.The response to the SARS outbreak involved a combination of containment measures, public health interventions, and scientific research. Quarantine measures were implemented to isolate suspected cases and prevent further transmission. Additionally, public health campaigns emphasized the importance of hand hygiene, respiratory etiquette, and social distancing to reduce the spread of the virus.Scientific research played a crucial role in understanding the SARS virus and developing effective diagnostic tests and treatments. The genome of SARS-CoV was sequenced, enabling researchers to develop specificdiagnostic tests to identify infected individuals quickly. Moreover, clinical trials were conducted to evaluate the efficacy of antiviral drugs and supportive therapies in treating SARS patients.The SARS outbreak also had significant socio-economic implications, impacting various sectors such as travel, tourism, and healthcare. Travel advisories and restrictions were imposed, leading to a decline in international travel and tourism revenues. Healthcare systems were stretched to their limits as hospitals dealt with surges in patients requiring medical care.In the aftermath of the SARS outbreak, lessons were learned, and efforts were made to strengthen global preparedness and response to emerging infectious diseases. The World Health Organization (WHO) implemented the International Health Regulations (IHR), which aim to prevent, detect, and respond to public health emergencies of international concern.Moreover, investments were made in research anddevelopment to develop vaccines and therapeutics for emerging coronaviruses. This preparedness proved invaluable when another coronavirus, SARS-CoV-2, emerged in late 2019, causing the COVID-19 pandemic. The knowledge and experience gained from the SARS outbreak helped inform the response to the COVID-19 pandemic, albeit with its unique challenges and complexities.In conclusion, the SARS outbreak was a wake-up call for the global community, highlighting the threat posed by emerging infectious diseases and the need for coordinated action to mitigate their impact. By understanding the origins, transmission dynamics, and response strategies to the SARS outbreak, we can better prepare for future pandemics and safeguard public health on a global scale.。
如何对待病毒伤害英语作文Title: Coping with Viral Infections: A Comprehensive Approach。
Introduction:In recent times, the world has been grappling with the challenges posed by viral infections. Whether it's the seasonal flu, novel viruses like COVID-19, or other infectious diseases, the impact on individuals andsocieties can be profound. In this essay, we will explore strategies for dealing with viral infections, emphasizing prevention, treatment, and societal responses.Prevention:Prevention is often the most effective strategy in dealing with viral infections. The old adage, "preventionis better than cure," holds true in this context. There are several preventive measures individuals can take to reducethe risk of viral infections:1. Vaccination: Vaccines play a crucial role in preventing viral infections. They stimulate the immune system to recognize and fight off specific viruses, thereby reducing the likelihood of infection and transmission. Governments and health authorities should promotevaccination campaigns to ensure widespread immunization coverage.2. Hygiene Practices: Basic hygiene practices such as regular handwashing with soap and water, covering mouth and nose when coughing or sneezing, and avoiding close contact with sick individuals can significantly reduce the spreadof viruses.3. Wearing Masks: In situations where viraltransmission is high, wearing masks can serve as a barrierto prevent the inhalation and exhalation of viral particles. This practice gained widespread acceptance during theCOVID-19 pandemic and remains relevant in crowded or high-risk settings.4. Environmental Measures: Keeping living and working spaces clean and well-ventilated can help reduce the survival and spread of viruses. Regular disinfection of surfaces and proper waste management are essential components of environmental hygiene.Treatment:Despite preventive efforts, viral infections may still occur. In such cases, prompt and appropriate treatment is essential to alleviate symptoms, prevent complications, and reduce the spread of the virus. Here are some key aspects of treatment:1. Antiviral Medications: For certain viral infections, antiviral medications may be available to inhibit the replication of the virus or alleviate symptoms. These medications are most effective when administered early in the course of the illness.2. Symptomatic Relief: Many viral infections causesymptoms such as fever, cough, and body aches. Over-the-counter medications can provide symptomatic relief and improve the patient's comfort level while their immune system fights off the infection.3. Supportive Care: In severe cases or when complications arise, supportive care may be necessary. This can include interventions such as oxygen therapy, intravenous fluids, and respiratory support to maintain vital functions until the body recovers.4. Isolation and Quarantine: To prevent further spread of the virus, individuals diagnosed with a viral infection may need to isolate themselves from others or undergo quarantine measures as recommended by health authorities.Societal Responses:In addition to individual efforts, addressing viral infections requires coordinated responses at the societal level. Governments, healthcare systems, and communities must work together to mitigate the impact of outbreaks andensure the well-being of the population. Key societal responses include:1. Public Health Measures: Public health authorities play a central role in monitoring the spread of viral infections, implementing control measures, and providing accurate information to the public. This can include surveillance, contact tracing, and public awareness campaigns.2. Healthcare Infrastructure: Adequate healthcare infrastructure is essential for managing viral outbreaks effectively. This includes sufficient hospital beds, medical supplies, and trained healthcare personnel to handle the influx of patients.3. Research and Development: Investing in research and development is critical for advancing our understanding of viral infections and developing new vaccines, treatments, and diagnostic tools. Collaborative efforts between scientists, pharmaceutical companies, and governments can accelerate progress in this field.4. Social Support: During outbreaks, individuals and communities may face various challenges, including economic hardship, social stigma, and mental health issues. Providing social support services such as financial assistance, mental health counseling, and community outreach programs can help mitigate these challenges.Conclusion:Dealing with viral infections requires a multifaceted approach that encompasses prevention, treatment, and societal responses. By implementing effective strategies at both the individual and societal levels, we can reduce the burden of viral illnesses, protect vulnerable populations, and safeguard public health. It is imperative that we remain vigilant, adaptable, and collaborative in ourefforts to combat viral infections and ensure the well-being of all.。
疾病有关的英语作文Title: The Impact of Diseases on Society。
Introduction:Diseases have always been a significant concern for societies worldwide, impacting individuals, communities, and entire nations. From ancient times to the present day, diseases have shaped human history, influencing social structures, economies, and public health policies. In this essay, we will explore the multifaceted impact of diseases on society.Healthcare Systems:One of the most immediate effects of diseases on society is the strain they place on healthcare systems. Infectious diseases, chronic illnesses, and pandemics necessitate substantial resources, including medical personnel, facilities, and supplies. Additionally, thetreatment and management of diseases often incur high financial costs, both for individuals and governments. As a result, healthcare systems must constantly adapt and evolve to meet the challenges posed by various diseases.Economic Consequences:Diseases can have profound economic consequences, affecting productivity, employment, and overall economic growth. During outbreaks of infectious diseases such as influenza or COVID-19, workplaces may temporarily close, disrupting supply chains and reducing consumer spending. Moreover, individuals who become ill may incur medical expenses and lose income due to absenteeism or disability. In extreme cases, widespread disease outbreaks can lead to economic recession or depression, further exacerbating social inequalities.Social Dynamics:The social impact of diseases extends beyond their direct effects on health and the economy. Fear of contagioncan lead to social stigma and discrimination against affected individuals or communities. Historically, diseases such as leprosy, HIV/AIDS, and tuberculosis have been associated with social ostracism and marginalization. Moreover, disease outbreaks can strain social cohesion, leading to panic, scapegoating, and the breakdown of trust within communities. Addressing these social dynamics requires not only medical interventions but also efforts to promote empathy, solidarity, and inclusivity.Public Health Policies:In response to the challenges posed by diseases, governments and public health authorities implement various policies and interventions aimed at prevention, control, and mitigation. These may include vaccination campaigns, quarantine measures, health education initiatives, and surveillance systems to monitor disease trends. However, the effectiveness of such policies depends on factors such as access to healthcare, socioeconomic disparities, and public compliance. Furthermore, debates over issues such as mandatory vaccination or individual freedoms highlight thecomplex ethical and political considerations inherent in public health governance.Global Health Security:In an interconnected world, diseases can spread rapidly across borders, transcending geographical, cultural, and political boundaries. Therefore, ensuring global health security requires international cooperation and coordination. Initiatives such as the World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis and Malaria play crucial roles in addressing global health challenges and promoting equitable access to healthcare. Additionally, advances in medical research and technology, such as the development of vaccines andantiviral drugs, contribute to the prevention and control of diseases on a global scale.Conclusion:In conclusion, diseases have a profound and far-reaching impact on society, affecting healthcare systems,economies, social dynamics, public health policies, and global health security. Addressing the complex challenges posed by diseases requires a multifaceted approach that integrates medical, social, economic, and political perspectives. By working together to prevent, control, and mitigate the effects of diseases, societies can build healthier, more resilient communities for the future.。
如何预防流行疾病英文作文Title: Preventing Epidemics: Effective Measures for Disease Control。
In today's interconnected world, the spread of infectious diseases poses significant challenges to public health. Preventing epidemics requires a multifaceted approach that involves proactive measures at individual, community, and governmental levels. By implementing comprehensive strategies, we can mitigate the risk of outbreaks and safeguard the well-being of populations worldwide.First and foremost, promoting public awareness and education is crucial in preventing the spread of epidemics. Individuals must understand the importance of basic hygiene practices such as regular handwashing with soap and water, covering coughs and sneezes, and avoiding close contact with sick individuals. Furthermore, disseminating accurate information about the transmission routes and symptoms ofinfectious diseases helps people recognize potentialthreats and take appropriate precautions.In addition to individual actions, community engagement plays a vital role in epidemic prevention. Communities can establish robust surveillance systems to monitor disease trends and detect outbreaks early. By promptly identifying and isolating cases, communities can prevent further transmission and contain epidemics at their source. Moreover, fostering a culture of solidarity and cooperation within communities encourages adherence to preventive measures and reduces the risk of disease spread.Furthermore, governments play a central role in epidemic prevention through policy development and resource allocation. Investing in healthcare infrastructure, including hospitals, clinics, and laboratories, strengthens the capacity to respond to outbreaks effectively. Additionally, implementing regulations and guidelines for disease control, such as mandatory vaccination programs and travel restrictions during outbreaks, helps limit the spread of infectious diseases across borders.Furthermore, international collaboration is essentialin addressing global health threats. Through partnerships between countries and international organizations, we can share expertise, resources, and best practices for epidemic prevention and response. By coordinating efforts on a global scale, we can enhance preparedness and resilience to emerging infectious diseases and mitigate their impact on vulnerable populations.Moreover, advancements in technology and innovation offer valuable tools for epidemic prevention. Digital surveillance systems, predictive modeling, and rapid diagnostic tests enable early detection and timely intervention, reducing the burden of infectious diseases on healthcare systems. Furthermore, research into vaccines, antiviral medications, and other medical countermeasures accelerates the development of preventive strategies against emerging pathogens.In conclusion, preventing epidemics requires a comprehensive approach that encompasses individual actions,community engagement, governmental policies, international cooperation, and technological innovation. By prioritizing public health, raising awareness, and investing in preparedness, we can mitigate the risk of epidemics and protect the well-being of populations worldwide. Together, we can build resilient health systems capable of effectively responding to the challenges posed by infectious diseases.。
英语关于x病毒的作文The X virus, a novel and highly contagious pathogen, has emerged as a global health threat, posing significant challenges to healthcare systems and societies worldwide. Its rapid spread and unpredictable nature have raised concerns, prompting governments and health organizations to implement stringent measures to control its transmission and mitigate its impact.The X virus belongs to the family of RNA viruses, known for their ability to mutate rapidly. This geneticvariability makes it challenging to develop effective vaccines and treatments, as the virus can quickly adapt to evade immune responses and antiviral drugs. The X virus is primarily transmitted through respiratory droplets, making close contact with infected individuals a significant risk factor. It can also be spread through contact with contaminated surfaces or objects, highlighting the importance of maintaining good hygiene practices.The symptoms of the X virus vary depending on the individual's immune response and overall health. Common symptoms include fever, cough, shortness of breath, fatigue, and muscle aches. In severe cases, the virus can lead to pneumonia, acute respiratory distress syndrome (ARDS), and even death. The elderly, individuals with chronic conditions, and those with weakened immune systems are at higher risk of developing severe complications.The rapid spread of the X virus has overwhelmed healthcare systems in many countries. Hospitals are facinga surge in patients requiring intensive care, straining resources and leading to shortages of beds, ventilators,and healthcare personnel. The pandemic has also disrupted essential healthcare services, such as routine checkups and elective surgeries, further burdening healthcare systems.To combat the X virus, governments have implemented a range of measures aimed at controlling its transmission and protecting the population. These measures include lockdowns, travel restrictions, social distancing, and mandatory mask-wearing in public spaces. Mass testing and contact tracingefforts have also been crucial in identifying and isolating infected individuals, preventing further spread of the virus.The development of vaccines and treatments for the X virus is a top priority for researchers and scientists worldwide. Several vaccine candidates are currently undergoing clinical trials, and some have shown promising results. However, the rapid mutation rate of the virus poses a challenge, as vaccines may need to be adapted to new variants over time. Antiviral drugs are also being developed, aimed at inhibiting the replication of the virus and reducing its severity.The X virus pandemic has had a profound impact on societies beyond the healthcare sector. The economic consequences have been significant, with lockdowns and travel restrictions disrupting businesses and leading to job losses. The pandemic has also had a negative impact on mental health, with individuals experiencing anxiety, depression, and isolation due to social distancing and uncertainty about the future.As the world continues to grapple with the X virus pandemic, international cooperation and collaboration are essential. Sharing of knowledge, resources, and best practices can accelerate the development of effective vaccines and treatments, as well as inform public health strategies to mitigate the impact of the virus. The pandemic has also highlighted the importance of investingin healthcare systems, strengthening preparedness and response mechanisms to future health emergencies.In conclusion, the X virus is a global health threat that requires a multifaceted response from governments, healthcare systems, and societies. By implementingstringent measures to control transmission, investing in research and development, and promoting international cooperation, we can work towards mitigating the impact of this pandemic and safeguarding the health and well-being of populations worldwide.。
流行病的防治与控制英语作文The Containment and Control of PandemicsThe world has faced numerous pandemics throughout history, each posing a significant threat to global health and stability. Pandemics, defined as the widespread outbreak of an infectious disease across multiple countries or continents, have the potential to cause widespread devastation, overwhelming healthcare systems, disrupting economies, and claiming millions of lives. In recent years, the emergence of novel pathogens, such as the COVID-19 virus, has highlighted the urgent need for comprehensive strategies to effectively contain and control pandemics.Effective pandemic prevention and control requires a multifaceted approach that encompasses various aspects of public health, epidemiology, and international cooperation. At the forefront of this effort is the development and implementation of robust disease surveillance systems. These systems, which involve the continuous monitoring and reporting of disease trends, play a crucial role in early detection and rapid response to emerging outbreaks. By identifying the emergence of novel pathogens and tracking their spread, public health authorities can implement targetedinterventions to mitigate the impact of a pandemic.Another key component of pandemic control is the establishment of effective communication and coordination mechanisms. During a pandemic, timely and accurate information sharing among healthcare providers, government agencies, and the general public is essential. This allows for the dissemination of critical updates, guidelines, and safety protocols, enabling individuals and communities to take appropriate actions to protect themselves and their loved ones. Effective communication also facilitates the coordination of response efforts across different jurisdictions, ensuring a unified and cohesive approach to addressing the crisis.The development and distribution of effective vaccines and treatments are also vital in the fight against pandemics. Vaccine development, which typically involves extensive research, clinical trials, and regulatory approval processes, is a complex and time-consuming endeavor. However, the COVID-19 pandemic has demonstrated the remarkable scientific and technological capabilities that can be harnessed to accelerate vaccine development timelines. Alongside vaccines, the availability of effective treatments, such as antiviral drugs and targeted therapies, can significantly improve patient outcomes and reduce the burden on healthcare systems.In addition to medical interventions, the implementation of non-pharmaceutical interventions (NPIs) plays a crucial role in pandemic control. NPIs, such as social distancing measures, travel restrictions, and the use of personal protective equipment (PPE), can effectively limit the spread of infectious diseases by reducing the opportunities for transmission. The strategic deployment of these measures, tailored to the specific characteristics of a pandemic, can help flatten the curve of disease spread and alleviate the strain on healthcare resources.Underpinning the success of pandemic control efforts is the importance of international cooperation and global health governance. Pandemics know no borders, and their impact transcends national boundaries. Effective pandemic response requires the coordinated efforts of international organizations, national governments, and public health authorities to share information, resources, and best practices. This collaboration facilitates the development of harmonized policies, the equitable distribution of medical countermeasures, and the implementation of coordinated response strategies.Furthermore, the strengthening of public health infrastructure and the investment in research and development are crucial for enhancing pandemic preparedness. Robust healthcare systems, with adequate resources, trained personnel, and surge capacity, are betterequipped to manage the influx of patients during a pandemic. Similarly, ongoing research into emerging infectious diseases, the development of rapid diagnostic tools, and the exploration of novel therapeutic approaches can significantly improve the ability to respond effectively to future pandemics.In conclusion, the containment and control of pandemics require a comprehensive and coordinated approach that encompasses disease surveillance, effective communication, the development and distribution of medical countermeasures, the implementation of non-pharmaceutical interventions, and the fostering of international cooperation and global health governance. By leveraging scientific advancements, enhancing public health infrastructure, and fostering collaborative efforts, the global community can better prepare for and respond to the challenges posed by pandemics, safeguarding the health and well-being of people worldwide.。
介绍某种防疫药品英语作文Title: Introducing a Revolutionary Antiviral Medication。
In the wake of recent global health crises, the needfor effective antiviral medications has become morepressing than ever before. Among the latest advancements in this field is a groundbreaking antiviral medication that promises to revolutionize the way we combat infectious diseases. Developed through extensive research and cutting-edge technology, this medication offers new hope in the ongoing battle against viral outbreaks.Named ViralShield, this antiviral medication is the result of years of dedicated research by a team ofscientists and medical experts. Its formulation is based on innovative principles that target key mechanisms of viral replication, effectively inhibiting the spread and progression of viral infections. Through rigorous testing and clinical trials, ViralShield has demonstratedremarkable efficacy in combating a wide range of viruses,including influenza, coronaviruses, and other respiratory pathogens.One of the most significant features of ViralShield is its broad spectrum of activity. Unlike traditionalantiviral medications that are specific to particular viruses, ViralShield exhibits effectiveness againstmultiple viral strains, making it a versatile tool in the fight against emerging infectious diseases. This broad-spectrum activity is attributed to its unique mechanism of action, which disrupts viral replication at various stages, thereby hindering the virus's ability to proliferate and cause widespread infection.Moreover, ViralShield boasts an excellent safety profile, ensuring minimal adverse effects and high tolerability among patients. Extensive preclinical studies and clinical trials have demonstrated the medication's safety and tolerability, paving the way for its approval by regulatory authorities worldwide. This approval underscores the confidence of regulatory agencies in ViralShield's efficacy and safety, further validating its potential as afrontline defense against viral outbreaks.In addition to its therapeutic benefits, ViralShield offers practical advantages that enhance its utility inreal-world settings. Its oral formulation allows for convenient administration, facilitating widespread distribution and accessibility to patients across diverse populations. This ease of use is particularly advantageous in public health emergencies, where rapid deployment of antiviral medications is essential to containing outbreaks and mitigating their impact on society.Furthermore, the development of ViralShield represents a significant milestone in the field of antiviral drug discovery. By harnessing the latest advancements in biotechnology and pharmacology, researchers have unlocked new possibilities for combating infectious diseases and safeguarding public health. The success of ViralShield serves as a testament to the power of scientific innovation and collaboration in addressing global health challenges.Looking ahead, ViralShield holds immense promise forshaping the future of infectious disease management. As ongoing research continues to uncover new insights into viral pathogenesis and therapeutic targets, the potential applications of ViralShield are likely to expand, further cementing its role as a cornerstone of antiviral therapy. With its unprecedented efficacy, safety, and convenience, ViralShield stands poised to redefine the standard of care for viral infections and usher in a new era of global health security.In conclusion, ViralShield represents a paradigm shift in the field of antiviral medication, offering unparalleled efficacy, safety, and versatility in combating infectious diseases. Its development signifies a triumph of scientific ingenuity and collaboration, underscoring the transformative impact of biomedical research on public health. As we confront the ongoing challenges posed byviral outbreaks, ViralShield stands as a beacon of hope, guiding us towards a safer and healthier future for all.。
《2024年世界卫生组织慢性乙型肝炎患者的预防、诊断、关怀和治疗指南》推荐意见要点艾小委,张梦阳,孙亚朦,尤红首都医科大学附属北京友谊医院肝病中心,北京 100050通信作者:尤红,******************(ORCID:0000-0001-9409-1158)摘要:2024年3月世界卫生组织(WHO)发布了最新版《慢性乙型肝炎患者的预防、诊断、关怀和治疗指南》。
该指南在以下方面进行了更新:扩大并简化慢性乙型肝炎治疗适应证,增加可选的抗病毒治疗方案,扩大抗病毒治疗预防母婴传播的适应证,提高乙型肝炎病毒诊断,增加合并丁型肝炎病毒的检测等。
本文对指南中的推荐意见进行归纳及摘译。
关键词:乙型肝炎,慢性;预防;诊断;治疗学;世界卫生组织;诊疗准则Key recommendations in guidelines for the prevention,diagnosis,care and treatment for people with chronic hepatitis B infection released by the World Health Organization in 2024AI Xiaowei, ZHANG Mengyang, SUN Yameng, YOU Hong.(Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)Corresponding author: YOU Hong,******************(ORCID: 0000-0001-9409-1158)Abstract:In March 2024, the World Health Organization released the latest version of guidelines for the prevention, diagnosis,care and treatment for people with chronic hepatitis B infection. The guidelines were updated in several aspects,including expanding and simplifying the indications for chronic hepatitis B treatment,adding alternative antiviral treatment regimens,broadening the indications for antiviral therapy to prevent mother-to-child transmission,improving the diagnosis of hepatitis B virus,and adding hepatitis D virus (HDV)testing. This article summarizes and gives an excerpt of the recommendations in the guidelines.Key words:Hepatitis B, Chronic; Prevention; Diagnosis; Therapeutics; World Health Organization; Practice Guideline近年来,慢性乙型肝炎(CHB)在预防、诊断、治疗等方面取得重要进展。
慢性乙型病毒性肝炎相关性肝癌危险因素及预测因子研究进展徐佰国,韩涛,向慧玲(天津医科大学三中心临床学院消化内科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆研究所,天津300170)[关键词]慢性乙型病毒性肝炎;肝原发恶性肿瘤;肝癌;危险因素;预测因子;H B V;HCC肝细胞癌已成为世界范围内癌症死亡的主要原因[1]。
而 慢性乙型病毒性肝炎(chronic hepatitis-B,C H B)是全世界发 生肝癌、肝硬化并发症和肝病相关死亡的主要病因之一[2-4]。
由于慢性乙型肝炎(CH B)患者肝脏疾病的进展与病毒的活性 复制密切相关,高水平的HBV D N A被认为是疾病进展的独立 危险因素,因此,通过抗病毒抑制乙肝病毒可以降低肝硬化和 肝癌的发生风险。
干扰素(包括聚乙二醇干扰素)及核苷 (酸)类似物的出现明显减低了慢性乙型病毒性肝炎相关性肝 癌的发生[5-6],但尚不能完全消除[7],仍有很高比例的正在接 受抗病毒治疗的慢性乙型病毒性肝炎患者发生肝癌。
肝癌的 早期诊断不仅可提高肝癌的治愈可能性[8-13],更是减低成本,提高效益的有效途径[14]。
肝癌对化疗药物不敏感,部分肝切 除、早期肝癌微创治疗、肝移植在内的治疗仍是肝癌为数不多 可行的治疗方法。
然而,只有不到30%的肝癌患者在发现时 有机会进行上述治疗。
因此,为了提高肝癌患者的整体生存 率,迫切需要改进早期诊断方法,以便对患者进行有效的治 疗。
关于慢性乙型病毒性肝炎患者预后因子的研究成为近年 来研究热点,且更新较快,本文就当前针对慢性乙型病毒性肝 炎进展为肝癌高危因素的研究进展做一综述。
1乙型病毒性肝炎相关肝癌的危险因素研究慢性乙型肝炎疾病进展的危险因素可分为三类:宿主因 素、病毒因素和肝脏因素[6]。
宿主因素包括年龄、男性、肝癌 家族史、肥胖、遗传易感性、吸烟、酗酒、糖尿病和免疫状态等[|5]。
病毒因素包括高血清乙肝表面抗原(H BsAg)、乙型肝 炎病毒E抗原(HBeAg)阳性、高水平的HBV DNA、H B V基因 型和H B V突变体[16-17]。
大学英语四级疫情英文表达传染防控1.国际关注的突发公共卫生事件Public Health Emergency of International Concern (PHEIC)2.乙类传染病Category B infectious diseases3.人传人person-to-person/human-to-human transmission4.行走的传染源mobile source of infection5.潜伏期incubation/latent period6.无症状的潜伏期silent/asymptomatic incubation period7.特定传染病specific infectious disease8.病毒携带者virus carrier9.无症状携带者asymptomatic carrier10.超级传播者super spreader11.飞沫传播droplet transmission12.接触传播contact transmission13.病毒的蔓延spread of a virus14.隐性感染covert/silent/inapparent/subclinical infection15.外源性感染exogenous infection16.密切接触者close contact17.接触者追踪contact tracing18.传染途径route of transmission19.传播方式mode of transmission20.宿主host21.易感人群susceptible/vulnerable population22.医院/院内感染nosocomial infection;hospital-acquired infection23.职业暴露occupational exposure24.确诊病例confirmed case25.疑似病例suspected case26.散在病例sporadic case27.输入性病例imported case28.二代病例second-generation case29.传染性transmissibility;infectivity30.致病性pathogenicity31.疫情epidemic;outbreak32.疫区affected area33.发病morbidity34.发热病人patients with fever;febrile patients;fever patients35.重症severe case36.发病率incidence rate37.死亡率mortality rate38.病死率(致死率)fatality/mortality/death rate39.治愈率recovery rate40.疫情防控epidemic prevention and control41.监测体温to monitor body temperature42.体温检测to check body temperature43.早发现、早隔离early detection and early isolation44.隔离治疗to receive treatment in isolation45.自我隔离to quarantine yourself in your home;self-monitored quarantine46.临床数据clinical data47.核酸检测nucleic acid testing(NAT)48.血清诊断serodiagnosis49.自觉接受医学观察to present yourself to medical observation50.解除医学观察to be discharged from medical observation51.诊断、治疗、追踪和筛查diagnosis,treatment,tracing and screening52.预防措施preventive measure53.疫苗vaccine54.戴口罩to wear a mask55.勤洗手/仔细洗手to wash your hands often/carefully56.消毒disinfection57.避免去人多的地方avoid crowds58.健康筛查health screening59.旅行限制travel restrictions60.健康申报表health declaration form61.海鲜市场seafood market62.活体农贸市场live animal market63.湿货市场wet market64.野味bushmeat;game65.果子狸masked palm civet66.蝙蝠bat67.竹鼠bamboo rat68.獾badger疫病名称1.冠状病毒coronavirus2.2019新型冠状病毒2019novel coronavirus(2019-nCoV)3.肺炎pneumonia4.病毒性肺炎viral pneumonia5.不明原因肺炎pneumonia of unknown etiology/cause6.严重急性呼吸综合征(非典)severe acute respiratory syndrome(SARS)7.严重急性呼吸道感染severe acute respiratory infection(SARI)8.急性呼吸窘迫综合征acute respiratory distress syndrome(ARDS)9.中东呼吸综合征Middle East respiratory syndrome(MERS)10.呼吸道疾病(呼吸系统疾病)respiratory diseases政策举措1.突发公共卫生事件public health emergency2.启动重大突发公共卫生事件一级响应to activate first-level public health emergency response3.掌握情况,不漏一人to have full knowledge of the situation(of the community)and leave no one unchecked4.遏制疫情蔓延to contain the outbreak5.封城A city is on lockdown./A city goes into lockdown.6.延迟开学to postpone the reopening of schools7.延长春节假期to extend the Chinese New Year holiday8.(公共场所)消毒、通风以及体温检测disinfection,ventilation and body temperature monitoring(in public areas)9.应急医院makeshift hospital10.火神山医院Huoshenshan Hospital(in Wuhan)11.雷神山医院Leishenshan Hospital(in Wuhan)12.暂停海外团队旅行to suspend overseas group tours13.关闭景点to close scenic spots14.取消大型集会to cancel mass gatherings15.减少外出to make fewer trips outside16.控制人口流动to curb population flow17.两周观察期two-week observation period18.停运长途汽车to halt long-distance buses19.调减市内公交to reduce the frequency of bus services in the city20.特殊报销政策special reimbursement rules21.紧平衡in tight balance22.医疗物资紧缺shortage of medical supplies23.日常基本生活物资daily necessities24.跨境采购cross-border procurement25.囤积食物to stock up on food26.捂货惜售hoarding27.瞒报to underreport28.哄抬价格price gouging29.顶格处罚the maximum penalty机构、职业群体和场所名称1.世卫组织World Health Organization(WHO)2.中央应对新型冠状病毒感染肺炎疫情工作领导小组(中央应对疫情工作领导小组) Leading Group of the CPC Central Committee for Novel Coronavirus Prevention and Control3.国家卫生健康委员会(国家卫健委)National Health Commission(NHS)4.中国疾病预防控制中心(中国疾控中心)Chinese Center for Disease Control and Prevention(China CDC)5.国家医疗保障局(国家医保局)National Healthcare Security Administration(NHSA)6.医疗机构medical institution7.卫生机构health institution8.医疗从业者medical practitioner;healthcare professional9.医疗人员medical personnel;health workforce;health workers10.一线医护人员frontline health workers11.钟南山Zhong Nanshan,a prominent Chinese expert in respiratory diseases(anda hero of the2003fight against SARS)12.定点医院designated hospitals13.发热门诊fever clinic14.重症监护病房intensive care unit(ICU)15.检疫所quarantine office16.药店pharmacy;drugstore病理症状1.病理pathology2.病原体pathogen3.病毒变异virus variation4.病毒突变virus mutation5.临床表现clinical picture6.上呼吸道感染upper respiratory tract infection(URTI)7.低氧血症hypoxemia;low blood oxygen8.纤维化fibrosis9.肺脓肿lung abscess10.双肺浸润性病灶infiltration in both lungs11.发热fever12.乏力fatigue13.干咳dry cough14.头疼headache15.胸闷chest distress;chest oppression16.心慌palpitations17.恶心想吐nausea18.腹泻diarrhea19.呼吸困难dyspnea;respiratory distress;breathing difficulties20.呼吸急促(气促)shortness of breath;panting21.感染性休克septic shock器具名称1.红外体温测量仪infrared thermometer2.体温检测热像仪thermal imaging camera for temperature monitoring3.诊断器具diagnostic tool/kit4.消毒液disinfectant;antiseptic solution5.消毒湿巾disinfectant/antiseptic wipes6.含酒精洗手液alcohol-based hand rub/sanitizer7.口罩facemask;mask8.N95口罩N95mask/respirator9.医用外科口罩surgical mask10.防护服protective suit11.护目镜goggles12.一次性手套disposable gloves13.负压救护车negative pressure ambulance其他医学名词1.国际卫生条例International Health Regulations(IHR)2.流行病学epidemiology3.流行病学调查(流调)epidemiological investigation4.呼吸器官respiratory organs5.呼吸道respiratory tract6.消化系统digestive system7.神经系统nervous system8.肾功能renal function9.流感influenza;flu10.结膜炎conjunctivitis;pink eye11.宿疾、慢性病chronic ailment;chronic disease12.高血压hypertension;high blood pressure13.糖尿病diabetes;diabetes mellitus14.心血管病cardiovascular disease15.基因序列genetic sequence16.基因结构genetic structure17.试剂reagent18.诊断diagnosis19.检测样本test sample20.医学观察medical watch;medical observation21.病毒分离virus isolation22.抗病毒药antiviral drug23.退烧药febrifuge;antipyretic。
Received: 26.07.2011 Accepted: 24.08.2011J Gastrointestin Liver DisSeptember 2011 V ol. 20 No 3, 293-298Address for correspondence: Prof. Ioan Sporea Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Timisoara, Romania Email: isporea@umft.roResponse to Standard of Care Antiviral Treatment in Patients with HCV Liver Cirrhosis – a Systematic ReviewSimona Bota 1, Ioan Sporea 1, Alina Popescu 1, Roxana Sirli 1, Adriana Maria Neghina 2, Mirela Danila 1, Mihnea Strain 11) Department of Gastroenterology and Hepatology; 2) Department of Biochemistry, Victor Babes University of Medicine and Pharmacy, Timişoara, RomaniaAbstractBackground :Patients with HCV liver cirrhosis are a category difficult to treat. The aim of this study was to establish the sustained virological response (SVR) rates in HCV patients with liver cirrhosis treated with standard of care therapy (Pegylated Interferon and Ribavirin for 48 weeks in genotypes 1 and 4 and 24 weeks in genotypes 2 and 3). methods :Searching the PubMed, Medline, Lilacs, Scopus, Ovid and Medscape databases we identified all the articles published until February 2011 that included only HCV cirrhotic patients. These studies evaluated the SVR after standard of care treatment: Pegylated Interferon alpha 2a (doses ranging between 135-180 µg/week) or Pegylated Interferon alpha 2b (1 or 1.5 µg/kg/week) and Ribavirin (doses ranging between 800-1200 mg/day). We used the following key words: HCV, liver cirrhosis, sustained virological response (SVR). Results :The overall SVR rate was 33.3% (95%CI-confidence interval=30.6-36.2%). SVR was significantly higher in patients with genotypes 2 and 3 (422 patients) as compared to those with genotypes 1 and 4 (692 patients): 55.4% (95%CI=50.7-60.1) versus 21.7% (95%CI=18.7-25), p<0.0001. Conclusion :The overall SVR rate in cirrhotic patients treated with standard of care therapy is 33.3%, but lower in cases affected by genotypes 1 and 4 (21.6%) which makes them a priority regarding the development of more potent drugs for effective treatment.Key wordsHepatitis C – HCV – liver cirrhosis – sustained virological response – systematic review – pegylated interferon – ribavirin. IntroductionChronic HCV infection is an important public health concern worldwide. The World Health Organization has estimated the prevalence of HCV infection at about 3%, with approximately 170 million affected people [1]. In Europe, the estimated prevalence of 1% varies largely among different countries [2]. HCV is responsible for 25-30% of global cases of cirrhosis associated with an annual risk of hepatic decompensation and hepatocellular carcinoma in up to 5% and 1-4% cases, respectively [3-4]. In patients with compensated liver cirrhosis, the 5-year risk of decompensation is estimated at 15-28%, and the risk of hepatocellular carcinoma is 1.4-6.7% annually [5-6]. HCV liver cirrhosis is the most common indication for liver transplantation. In patients with detectable viral HCV load before transplantation, recurrence of HCV is universal and immediate after transplantation [7]. Some studies show that both the graft and the patients’ survival rates in HCV-infected cases are shorter as compared to non-HCV-infected ones following liver transplantation [8].Pegylated Interferon and Ribavirin represent the standard of care (SOC) treatment in chronic HCV infection. In randomized controlled trials, the SVR rates were reported as follows: 42-46% in patients with genotype 1 infection, and 76-82% in patients with genotype 2 or 3 infection [9-10].Patients with HCV-related cirrhosis usually have a poor therapeutic response as well as reduced tolerance to therapy [11-12], but the risk of complications is reduced in patients with SVR [13].This systematic review aims at identifying and analyzing the pooled SVR rates in HCV patients with liver cirrhosis treated with SOC therapy.methodsEligibility criteriaThis review included all studies published in English until February 2011 which evaluated the SVR rates in cirrhotic patients with HCV infection treated with SOC therapy: Pegylated Interferon alpha 2a (dosage range: 135-180 µg/294 Bota et al week) or Pegylated Interferon alpha 2b (dosage: 1 or 1.5 µg/kg/week) and Ribavirin (dosage range: 800-1200 mg/day).Patients with genotypes 1 and 4 underwent treatment for 48weeks, whereas those with genotypes 2 and 3 were treated for24 weeks. The diagnosis of cirrhosis was established eitherby liver biopsy or by clinical, ultrasonographic, endoscopic,laparoscopic signs of cirrhosis. Studies that included liver-transplanted patients were excluded from the analysis.OutcomesThe preestablished primary outcome was SVR ratein HCV liver cirrhosis. SVR was defined as undetectablehepatitis C virus RNA in serum by real-time polymerasechain reaction (PCR) 6 months after discontinuationof therapy. The secondary outcomes were the possiblerelationships between the SVR rate in cirrhotic patients andthe following factors: genotype of hepatitis C virus, patientstatus (naïve or formerly treated with standard Interferon-IFN standard and Ribavirin), type of Pegylated Inteferonused in SOC therapy, portal hypertension (presence ofesophageal varices) or decompensation of the disease (classChild-Pugh B or C).Data sources and searchesRelevant studies published until February 2011 weresearched in Medline, Lilacs, Scopus, Ovid and Medscapedatabases using the following keywords: HCV, hepatitis C,liver cirrhosis, sustained virological response, SVR.Study selection and data collectionTwo authors independently screened titles and abstractsfor potential eligibility and the full texts for final eligibility. Weextracted the data using a standardized data collection formto record study design and methodological characteristics,patient characteristics, interventions, outcomes, and missingoutcome data.Data synthesis and analysisStatistical analyses were carried out with the software package SPSS version 17.0 for Windows (SPSS Inc., Chicago, IL). Descriptive statistics (percentage, 95% confidence interval - 95%CI) were calculated for each variable as appropriate. Standard binomial tests for differences in proportions were used to compare patient subgroups (…n” designates the total number of patients included in a particular subgroup). A p-value of less than 0.05 was regarded as statistically significant. ResultsOf 7,326 titles identified at the initial search, 7,315 were excluded based on either of the following reasons: data published only in an abstract, duplicated titles, not only cirrhotics included in the study, treatment other than SOC therapy (Fig.1). Finally, 11 papers including 1,149 patients (764 men - 66.4% and 385 women - 33.6%) with HCV liver cirrhosis were retrieved for the analysis [14-24] (Table I). Nine studies were from Europe [14, 15-20, 22-24] and two studies were from Asia [16, 21].The SVR rate for each study included in this analysis is presented in Table II.The overall SVR rate was 33.3% (95%CI=30.6-36.2). SVR was significantly higher in patients with genotypes 2 and 3 (n=442) as compared to those with genotypes 1 and 4 (n=692): 55.4% (95%CI=50.7-60.1) versus 21.7% (95%CI=18.7-25), p<0.0001.Nine articles [14, 16-21, 24] reported on SVR rates in naïve HCV cirrhotic patients, whereas four studies [14, 16, 17, 24] reported on SVR rates in patients previously treated with standard IFN and Ribavirin. SVR was higher in naïve patients (n=419) as compared to those previously treated (n=131): 41% (95%CI=36.3-45.9) versus 25.9% (95%CI=18.9-34.5), p=0.003.Pegylated Interferon alpha 2a was used in 4 studies [15, 16, 18, 22] and Pegylated Interferon alpha 2b was administered in 7 studies [15, 16, 19-21, 24]. The SVR rate was similar for Pegylated Interferon alpha 2a (n=432) and Pegylated Interferon alpha 2b (n=516): 35.6% (95%CI=31.2-40.4) versus 34.9% (95%CI=30.8-39.2), p=0.9.Two studies [15, 21] reported on SVR rates in cirrhotic patients with or without esophageal varices. The rate values were similar in cirrhotic cases regardless of the presence(n=157) or absence (n=434) of the esophageal varices: 26.8% Fig 1. Study screening flow chartResponse to standard of care antiviral treatment in HCV liver cirrhosis 295(95%CI=20.2-34.5) versus 27.2% (95%CI=23.1-31.7), p=1.The Child-Pugh class (that shows the decompensation of liver cirrhosis) was reported in 7 studies, of which 5 included patients with class A cirrhosis [14-16, 18, 20] and the other 2 included class B cirrhotic patients [16, 19]. The SVR rates were similar for class A (n=854) and classTable I. Characteristics of the studies included in the systematic analysisStudy Study design Numberof patients Age (years)Weight HCVgenotypeBaselinetreatmenthistoryChild-Pugh classTreatmentSyed 2008 [14]retrospectivecohort study10452 ± 7.682 ± 15 kg(mean weight)1, 2, 3 Naïve andpreviouslytreatedA PegIFN alpha 2a (180µg/week ) or alpha 2b(1-1.5 µg/kg/week)Ribavirin (800-1200mg/day)Fernandez-Rodriguez 2010 [15]retrospectivecohort study56851 ± 0.526.4 ± 3.78kg/m²(mean body massindex –BMI)1, 2, 3Naïve andpreviouslytreatedA PegIFN alpha 2a (180µg/week) or alpha 2b(1.5 µg/kg/week)Ribavirin (800-1200mg/day)Butt 2009 [16]prospectivecohort study6646.2 ± 10.122.3 ± 3.1 kg/m²(mean BMI)3Naïve andpreviouslytreatedA, B PegIFN alpha 2a (180µg/week) or alpha 2b(1 µg/kg/week)Ribavirin (10-12 mg/kg/day)Giannini 2009 [17]retrospectivecohort study8556 ± 9Not specified1, 2, 3, 4Naïve andpreviouslytreatedA, B PegIFN alpha 2a (180µg/week) or alpha 2b(1.5 µg/kg/week)Ribavirin (800-1200mg/kg/day)Helbling 2006 [18]randomizedcontrolledtrial (standarddoses vs. lowdoses)6447(median age)74 kg(median weight)1, 2, 3, 4Naïve A PegIFN alpha 2a (180µg/week)Ribavirin (1000-1200mg/kg/day)Iacobellis 2009 [19]prospectivecohort study94Not specified Not specified1, 2, 3, 4Naïve B Pegylated Inteferonalpha 2b (1.5 µg/kg/week)Ribavirin (800-1200mg/day)Roffi 2008 [20]randomizedcontrolledtrial (PegIFNvs. IFNstandard)5756 (medianage)75 kg(median weight)1, 2, 3Naïve A PegIFN alpha 2b (1µg/kg/week)Ribavirin (800-1200mg/day)Sood 2006 [21]retrospectivecohort study2848.3 ± 773.9±11.2 kg(mean weight)3 (25/28patients)and notspecifiedfor theotherpatientsNaïve A, B PegIFN alpha 2b (1µg/kg/week)Ribavirin (10-12 mg/kg/day)Tekin 2008 [22]cohort study2054.2 ± 5.9Not specified1NotspecifiedA, B PegIFN alpha 2a (135µg/week)Ribavirin (1000-1200mg/kg/day)Morreno-Planas 2005 [23]cohort study1252 ± 8Not specified1, 3Naïve andpreviouslytreatedA, B PegIFN alpha 2b (1.5µg/kg/week)Ribavirin (10.6 mg/kg/day)Di Marco 2007 [24]randomizedcontrolledtrial (PegIFNalpha 2B +Ribavirin vs.PegIFN alpha2b)5257 ± 6.671±10.1 kg(mean weight)1, 2, 3, 4Naïve andpreviouslytreatedA, B PegIFN alpha 2b (1µg/kg/week)Ribavirin (800 mg/kg/day)296 Bota et alB (n=99) HCV liver cirrhosis treated with SOC therapy:34.2% (95%CI=30.2-39.6) versus 34.3% (95%CI=30.4-39.9), p=0.9.DiscussionThis systematic review summarizes and analyzes the available data on SVR in HCV liver cirrhosis managed with SOC therapy and finally shows an overall value of 33.3%, with better results in genotypes 2 and 3 as compared to genotypes 1 and 4 ( p<0.0001).A recent meta-analysis [25], that included 5,008 cases from 12 randomized controlled clinical trials, compared the SVR rates in patients treated with Pegylated Interferon alpha 2a plus Ribavirin versus Pegylated Interferon alfa 2b plus Ribavirin. Overall, Pegylated Interferon alpha 2a significantly increased the number of patients who achieved SVR versus Pegylated Interferon alpha 2b (47% versus 41%; risk ratio=1.11, 95%CI=1.04-1.19; p=0.004). Pegylated Interferon alpha 2a was associated with higher SVR than Pegylated Interferon alpha 2b in those affected by genotype1 (risk ratio=1.25, 95%CI=1.03-1.42) as well as genotypes2 and3 (risk ratio=1.11, 95%CI=1.02-1.22).Our systematic analysis in cirrhotic patients shows similar SVR rates regardless of the type of Pegylated Interferon used in SOC therapy (Pegylated Interferon alpha 2a -35.6% vs. Pegylated Interferon alpha 2b – 34.8%, p=0.9).Also the SVR rates did not differ significantly in patients with or without esophageal varices (p=1), and in patients with Child-Pugh class A or Child-Pugh class B cirrhosis (p=0.9). The results of the latter subgroup may have been biased by the low number of patients with Child-Pugh classB as compared to those with Child-Pugh class A cirrhosis(99 patients vs. 854 patients).As expected, the SVR rate was significantly lower in patients treated with standard IFN as compared to naïve patients ( p=0.003).The limitations of this systematic review are that not all the studies were randomized, and that the SVR rate according to the treatment status, the Child-Pugh class or the presence of esophageal varices were not analyzed in all the studies.Regarding the antiviral treatment in cirrhotic patients, Saab et al [26] published a study that tried to determine the most cost-effective timing for Pegylated Interferon plus Ribavirin treatment (48 weeks) in patients with advanced liver disease related to genotype 1 HCV infection. The study included about 4,000 participants followed over 17 years. A Markov model was constructed to compare treatment strategies: no treatment, antiviral therapy in patients with compensated cirrhosis, antiviral therapy in patients with decompensated cirrhosis, and antiviral therapy in patients with progressive fibrosis due to recurrent HCV post-transplantation. Outcomes of interest included the total cost per patient, number of quality-adjusted life years (QALYs) saved, cost per QALY saved, number of deaths and hepatocellular carcinomas and number of transplants required. Compared to the no-antiviral treatment strategy, treatment during compensated cirrhosis increased QALYs by 0.950 and saved 55.314 dollars, treatment during decompensated cirrhosis increased QALYs by 0.044 and saved 5511 dollars and treatment during posttransplant advanced recurrence increased QALYs by 0.061 and saved 3223 dollars. Treatment of patients with compensated cirrhosis resulted in 119 fewer deaths, 54 fewer hepatocellular carcinomas and 66 fewer transplantations with respect to the no-treatment strategy.So, even if the SVR rate in HCV cirrhotic patients with genotype 1+4 is very low (21.6% in our current review), with lots of adverse events (especially hematological: anemia, neutropenia, thrombocytopenia) which determined the discontinuation of therapy, according to the previous presented study [26], it is cost-effective to treat cirrhotic patients with antiviral therapy.The low SVR rate in genotypes 1 and 4 urges also the need for new therapies and new predictors of SVR even in cirrhotic patients treated previously with IFN standard.In recent years, several studies reported that genetic polymorphism in the IL28B gene, encoding interferon-lambda-3, is associated with an approximately twofold change in response to treatment [27-30].IL28B genotypes are significantly related to the SVR rates following SOC treatment (Pegylated Interferon plusTable II. The SVR in the studies included in analysisStudy Nr. patients included Nr. patients with SVR% of patients with SVR Syed 2008 [14]1042423 Fernandez-Rodriguez 2010 [15]56817430.6Butt 2009 [16]663857.5 Giannini 2009 [17]852225.8 Helbling 2006 [18]643250 Iacobellis 2009 [19]943335.1Roffi 2008 [20]572543.8Sood 2006 [21]281553.5Tekin 2008 [22]20630 Morreno-Planas 2005 [23]12325Di Marco 2007 [24]511121.5Response to standard of care antiviral treatment in HCV liver cirrhosis 297Ribavirin). In patients of European ancestry, CC genotype is associated with a twofold (95%CI=1.8-2.3) higher rate of SVR than the TT genotype [27]. It has been also shown that SVR rate was 69% in CC genotype as compared to 33% in TC genotype and 27% in TT genotype (p<0.0001) [31].No studies that analyzed the relationship between IL28B genotype and SVR matched the inclusion criteria used in this systematic review.In the latter years, several studies have used triple therapy (SOC therapy + direct antiviral agents) in patients with HCV genotype 1 infection [32-34]. The most studied direct antiviral agents were Boceprevir (SPRINT 2 trial) and Telaprevir (ADV ANCE and ILLUMINATE trials) [34, 35]. These trials included naïve patients and the proportion of patients with bridging fibrosis/cirrhosis was 20-23% in the ADV ANCE trial, and 7-11% in the SPRINT 2 trial.In the trial with Telaprevir, the SVR rate in patients with F0-F2 (n=290) was higher than in patients with F3-F4 (n=73) (78% vs. 62%, p=0.007) [36, 37]. Also, in the trial that used Boceprevir [35], the SVR rate was significantly higher in non-cirrhotic versus cirrhotic patients (odd ratio=2.5, 95%IC=1.4-4.6, p=0.003).The REALIZE trial used Telaprevir and Pegylated Interferon alpha 2a plus Ribavirin in patients with HCV genotype 1 infection who had no response or a partial response to previous therapy or who had a relapse after an initial response. A total of 663 patients were assigned to one of three groups: two which included Telaprevir and the control group with SOC therapy [38]. In cirrhotics, the SVR rates with SOC therapy as well as for the pooled 12 weeks Telaprevir + 48 weeks Pegylated Interferon and Ribavirin therapy were as follows: prior relapsers - 13% and 84%, respectively; prior partial responders - 20% and 34%, respectively; null-responders - 10% and 14%, respectively [38, 39].The RESPOND-2 trial, that used Boceprevir in patients previously treated, included prior relapsers and prior partial responders, but excluded the null responders. There were also three arms in this study: SOC therapy and two arms with Boceprevir (for 32 weeks and 44 weeks, respectively, in association with SOC therapy).The SVR rates for the three arms in patients with F3-F4 were 13%, 44% and 68%, respectively [40].A recent study [41] used both Pegylated Interferon alpha 2a and Pegylated Interferon alpha 2b in combination with Ribavirin and Telaprevir with similar rates of SVR.IL28B genotyping in the ADVANCE trial showed a higher SVR rate in CC genotype (90%) as compared to CT and TT genotypes (71% and 73%, respectively) [42]. Similarly, in the trial that used Boceprevir, the SVR rate was significantly higher in the CC genotype as compared with the CT and TT genotypes [43].This data shows that triple therapy had good results for the treatment of naïve patients affected by genotype 1 HCV with advanced fibrosis and cirrhosis – F3-F4 (62%) as compared to SOC therapy (SVR rate of 21.6% reported by this review in cirrhotic patients with genotype 1 and 4). Both SOC therapy and triple therapy are influenced by the IL28B genotype.In cirrhotic patients formerly treated with standard IFN, the SVR rate with SOC therapy in this review was 25.9%. Therefore, patients with genotype 1 HCV who do not achieve SVR need to be treated with triple therapy. The results of the studies presented above are very encouraging for prior relapser patients (84% in REALIZE trial) and satisfying for the partial responder patients (34% in REALIZE trial), but of important concern remain the non-responder patients (14% in REALIZE trail). The SVR rate obtained with triple therapy in cirrhotic non-responder patients is comparable with the value reported in those who underwent SOC therapy (10%). Thus, new drugs should be developed and made available to the former as soon as possible.ConclusionThe overall SVR rate in cirrhotic patients treated with standard of care therapy is 33.3%, but lower in cases affected by genotypes 1 and 4 which makes them a priority with regard to the development of more potent drugs for effective treatment.Conflicts of interestNone to declare.Reference1. Global surveillance and control of Hepatitis C. Report of a WHOConsultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat 1999; 6: 34-35.2. Touzet S, Kraemer L, Colin C, et al. Epidemiology of hepatitis C virusinfection in seven European Union countries: a critical analysis of the literature. HENCORE Group. (Hepatitis C European Network for Co-operative Research). 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