Hepatitis C – Diagnostik und Therapie

Abstract

Die Therapie der chronischen Virushepatitis C wurde in den letzten Jahren durch die Zulassung direkt antiviral wirksamer Substanzen revolutioniert. Mussten die ErstgenerationsproteaseinhibitorenTelaprevir und Boceprevir noch mit dem nebenwirkungsreichen Interferon kombiniert werden, so besteht die moderne HCV-Therapie nun aus Kombinationen verschiedener direkt antiviraler Wirkstoffe und erhöht die Heilungsraten in fast allen Patientenkollektiven auf mehr als 90%. Gleichzeitig ist die Therapiedauer verkürzt und das Nebenwirkungsspektrum deutlich reduziert worden. Bei schwierig zu behandelnden Patienten kann die Hinzunahme von Ribavirin erforderlich sein. Der Beitrag gibt einen Überblick zur Hepatitis C Infektion mit einem Schwerpunkt auf den aktuellen Therapieempfehlungen.

Kernaussagen

• Die Prävalenz der HCV-assoziierten Folgeerkrankungen wird in den kommenden Jahren noch steigen.

• Für fast jeden Patienten ergeben sich hocheffektive und nebenwirkungsarme Therapieoptionen mit einer Dauer von zumeist 12 Wochen.

• Zur Behandlung des in Deutschland dominierenden Genotyp 1 sind die Kombinationen Ledipasvir/ Sofosbuvir oder Paritaprevir/Ritonavir + Ombitasvir + Dasabuvir primär empfohlen.

• Die Zulassung neuer direkt antiviraler Substanzen wird 2016 das Spektrum und damit die Effektivität der Therapie erweitern.

Schlüsselwörter:

Hepatitis CVirus - akute HCV-Infektion - chronische HCV-Infektion - Diagnostik - antivirale Therapie

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