Jean Michel Pawlotsky教授：治愈时代下的丙肝优化管理

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How to optimize the treatment and management mode of hepatitis C in the era of DAA?

Prof.Jean-Michel Pawlotsky：Today, DAAs are very efficacious, leading to a cure of the HCV infection in the vast majority of treated patients. Optimizing treatment of hepatitis C means treating as many infected patients as possible. This implies simplification of all steps in the screening/diagnosis/treatment process and efficient linkage-to-care. Screening and diagnosis can be optimized by using either ELISA for anti-HCV antibody detection, or alternative methods including rapid diagnostic tests or dried blood spots. Reflex HCV RNA testing or HCV core antigen testing provide easy and rapid confirmation of active replication. In patients diagnosed with HCV infection, linkage-to-care is crucial. Simplified treatment regimens can be used with pangenotypic regimens in all patients after a simple pre-therapeutic assessment: confirmation of HCV replication, assessment of potential drug-drug interactions, and evaluation of liver fibrosis by means of a non-invasive test. The patients can then be treated with either sofosbuvir/velpatasvir for 12 weeks, or glecaprevir/pibrentasvir for 8 weeks (except treatment-experienced patients with compensated cirrhosis). SVR12 should be assessed at week 12 post-treatment, but given the very high SVR rates, such assessment is dispensable.

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Please talk about the latest research progress of hepatitis C in combination with clinical research?

Prof. Jean-Michel Pawlotsky：There is no longer any real need to do clinical trials of new drugs, and indeed there is no new drug development. Real-world studies are necessary to confirm the efficacy of the currently recommended pangenotypic regimens in some special population (decompensated liver disease, children, HBV-coinfected patients, men who have sex with men with high reinfection rates, etc). Studies on local implementation and methods to improve the HCV elimination efforts around the world are also required, especially in the context of the COVID-19 pandemic that slowed all initiatives aiming at screening, treating and eliminating viral hepatitis.

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What are the challenges and unmet needs for the treatment and clinical cure of hepatitis C in the next decade?

Prof.Jean-Michel Pawlotsky：The main challenge is to provide access to care, given that there are still approximately 70 million people infected with HCV and no hope for an efficient vaccine on the short-term. So studies should be aimed at improving any public health intervention that results in a better access to antiviral therapy and cure. In parallel, vaccine research may benefit from recent major progress made in the development of COVID-19 vaccines. Making treatment accessible, improving prevention of transmission in areas where the virus still circulates and developing an effective prophylactic vaccine are certainly the main HCV challenges for the next decade. Then, if a vaccine happens to work, key questions will be raised as to how Phase III trials could be organized and who could be the target of such vaccination, an uneasy question.