One viral factor: including viral load level, which is high for HCV RNA larger than 8× 105 IU/ml; In patients with viral genotype, genes 1 and 4 are relatively difficult to treat, while genes 2 and 3 are relatively easy to treat.
2. Drug factors and plans:
① Interferon combined with ribavirin. The main mechanism of interferon is immunomodulation and antivirus, and the antiviral effect of pegylated interferon is obviously higher than that of common interferon. Ribavirin has a direct antiviral effect. At present, the combination therapy of peginterferon and ribavirin is the most effective treatment for hepatitis C. Compared with long-acting interferon alone, the combination therapy has higher SVR rate and lower recurrence rate. Therefore, as long as patients have no contraindications to ribavirin, they must be combined with drugs.
(2) The therapeutic dose should be sufficient, namely, perone 1.5ug/kg/w (perone 180ug/ week) and ribavirin 900-1200mg;
③ Treatment should last for a course of treatment. The standard course of treatment for genotype 1 patients is 48 weeks, and that for genotype 2/3 patients is 24 weeks. Prolonging the course of treatment according to RGT principle and maintaining HCV RNA negative for 44 weeks (that is, maintaining antiviral treatment for 44 weeks after HCV RNA turns negative) can significantly improve the SVR of patients and reduce the recurrence rate. The study showed that among the patients whose RNA turned negative after 16-24 weeks of treatment, only 9% of the patients in the standard course group reached SVR, while 76% of the patients in the RGT group reached SVR. In China, the genotypes of hepatitis C patients are mainly 1b and 2,3, which are relatively good for treatment. Through standardized treatment, most patients can reach SVR, and after 5 years of follow-up, they will not relapse and achieve clinical cure! However, in our work, we realized that in order to cure hepatitis C radically and prevent recurrence, we should extend the course of antiviral treatment for several weeks as much as possible, so that patients can truly achieve SVR, avoid recurrence and re-treat. For example, the second course of treatment may be longer than the first course of treatment, which will cost more money and increase the psychological burden.
It is worth noting that the patients who failed or relapsed in the previous treatment are still effective when they are treated with interferon combined with ribavirin again. Studies have shown that for patients who have failed or relapsed interferon therapy in the past, if they are treated with pegylated interferon combined with ribavirin again, if the patients turn RNA negative at week 12 and HCV RNA turns negative for 44 weeks, 56% patients can still get SVR. In order to achieve higher SVR, it is necessary to maintain antiviral treatment for a longer period of time after HCV RNA turns negative. After HCV RNA turns negative, antiviral treatment needs to be maintained for 44 weeks.
Three factors of liver lesion degree:
① Compensatory cirrhosis will develop into decompensated cirrhosis without treatment. Once a patient has decompensated cirrhosis, antiviral therapy is ineffective and risky, which is generally difficult to treat. Therefore, patients with compensated liver cirrhosis should also be treated with antiviral therapy to delay the progress of liver cirrhosis and reduce the incidence of liver cancer.
② Patients with elevated ALT have better antiviral effect than patients with normal ALT;
For example, patients with leukopenia and thrombocytopenia caused by hypersplenism can be treated with antiviral therapy after splenectomy under normal blood routine. In the process of antiviral treatment, the occurrence of adverse events should be closely monitored;
④ Others: The efficacy of antiviral therapy in patients with hepatitis C complicated with fatty liver is relatively poor. At the same time of antiviral treatment, patients should improve their compliance and cooperate with the treatment of fatty liver.