214.4 📌 章末速蚘

  • HCV: ssRNA Flaviviridae, 6 genotypes, 58M chronic
  • Transmission: IDU #1, pre-1992 transfusion, Egypt iatrogenic, MSM + HIV+, vertical
  • Course: 80% chronic, cirrhosis 20% in 20-30 yr, HCC 3-5%/yr cirrhotic
  • Extrahepatic: mixed cryoglobulinemia, MPGN, B-cell lymphoma, porphyria, lichen planus, T2DM
  • Diagnosis: anti-HCV (screen) + HCV RNA PCR (active) + FibroScan
  • Treatment (DAA era):
    • Epclusa (sofosbuvir/velpatasvir) 12 wk pan-genotypic
    • Mavyret (glecaprevir/pibrentasvir) 8 wk pan-genotypic
    • Vosevi salvage
    • > 95% SVR12 = cure
  • No interferon, no ribavirin for most modern regimens
  • WHO 2030 elimination goal (90% Dx + 80% Tx + 65% mortality reduction)
  • Universal adult screening USA 2020+
  • Egypt elimination 2024 = model
  • No vaccine yet — Phase 2 candidates
  • Pediatric HCV: Mavyret 3+ yr, Epclusa 6+ yr
  • 盧醫垫 hint: 慢性 HCV + 糖 + 病人 — DAA treatment + HCC surveillance if cirrhotic; cure improves multiple comorbidities (cryo, neuropathy, glomerular, T2DM)