Aktuelle Therapie der Hepatitis-C-Virus-Infektion

Zusammenfassung

Neue Therapieansätze haben die Ansprechrate einer antiviralen Therapie bei Infektionen mit dem Hepatitis-C-Virus in den letzten Jahren deutlich verbessert. Die derzeitige Standardbehandlung therapienaiver Patienten mit chronischer HCV-Infektion ist eine Kombinationstherapie mit pegyliertem Interferon (PEG-IFN) und Ribavirin (RBV). Die dauerhaften Ansprechraten dieser Therapie liegen bei Genotyp 1-Patienten nach einer 48-wöchigen Behandlungsdauer zwischen 42 und 48 %, bei Genotyp 2/3-Patienten nach 24 Therapiewochen bei über 80 %. Neue Nukleosidanaloga werden möglicherweise zukünftig die Verträglichkeit und damit auch die Ansprechraten der antiviralen Kombinationsbehandlung verbessern. Ein viel versprechender neuer Therapieansatz ist die Langzeittherapie mit pegyliertem Interferon zur Senkung der Fibroseprogression und damit zur Senkung Zirrhose-assoziierter Komplikationen. In klinischer Erprobung sind ferner Proteaseinhibitoren sowie eine therapeutische Impfung mit dem E1-Hüllprotein des Hepatitis-C-Virus. Aufgrund des noch unklaren optimalen Behandlungsregimes für Patienten mit akuter HCV-Infektion, sollten diese in klinische Studien eingebunden werden.

Summary

New strategies have led to better results in the treatment of HCV infection during the last few years. At present the recommended treatment for patients with chronic hepatitis C is a combination of pegylated interferon and ribavirin. The sustained virological response rate of this combination therapy is 42 - 48 % for patients with genotype 1 after a course of 48 weeks and 80 % for patients with genotype 2 or 3 after a course of 24 weeks. New nucleoside analogas may lead to a better tolerance and better outcomes. A new approach is the long term monotherapy with pegylated interferon in order to reduce the progression of fibrosis and the incidence of cirrhotic complications. At present the effectivity of protease inhibitors and of a therapeutic immunisation with the E1 envelope protein of the hepatitis C virus are being examined. Because the optimal treatment strategy for patients with an acute hepatitis C infection is still unclear, these patients should be included in clinical studies.

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