Mindie H. Nguyen博士，美国斯坦福大学医学中心胃肠病学及肝脏病学教授，临床研究方向为肝脏病学和肝移植、肝癌和肿瘤、慢性乙肝和丙肝、非酒精脂肪肝、肝硬化等。在“第七届亚太肝病诊疗技术联盟（APALD）年会”上，Nguyen教授带来了题为“中低收入国家的丙型肝炎治疗”的专题报告，并于会议期间就美国肝炎发病情况、DAA在丙型肝炎的未来前景等话题接受了《国际肝病》的专访。

　　《国际肝病》：请您谈谈目前美国乙肝及丙肝发病情况？

　　Mindie H. Nguyen教授：总体来说在美国丙肝比乙肝更普遍。丙肝的发病率为1.8%，即总计患患者数为500万左右。乙肝患者比较少见，发病率不到0.5%，亚洲或者东欧移民人群的发病率高一些，可能会达到10%～15%。

　　Prof. Nguyen: In America or in the United States hepatitis C is much more common than hepatitis B, all for all. The prevalence of hepatitis C in the US is about one point eight percent (1.8%), so the total is about five million persons. Hepatitis B in the general population is actually rare, less than point five percent (0.5%). However, if we work with immigrants patients from Asia or Eastern Europe then the prevalence can be very high. It can be up to ten to fifteen percent.

　　《国际肝病》：关于低收入国家的丙肝治疗，您会建议患者选用何种治疗方案?

　　Mindie H. Nguyen教授：值得一提的是大约80%，即很大比例慢性丙肝患者生存在中低等收入国家。在这些地区，由于资源有限，这些患者的医疗选择和照顾需要真正被关注。我认为，未来直接抗病毒药物（DAA）治疗将占有重要地位。虽然现在DAA药物还很昂贵，但我相信在不远的将来会有所改善。这类药物与以往药物相比，更有效，且不需要专科医师处方，更容易获得。未来有望实现不需要初级保健医师甚至资深医师的治疗。另外，未来丙肝患者的治疗将更简便，因为药物足够安全，治疗过程中我们将不再需要做很多血液检查，这也为患者节省了开支。

　　Prof. Nguyen: The most important thing to remember and to mention about the treatment of chronic hepatitis C in lower income countries is that the vast majority, eighty percent, of patients with chronic Hepatitis C globally actually live in lower and middle income countries. And in this area resources are limited so the choice and the care of these patients has really be think off. I believe that the future should be direct acting antiviral therapies. Even though is very expensive now, I really believe that in the future it can get much cheaper. And this medication is much more potent, is very easy to take, it doesn’t require specialist. So with time, we can really work without primary care colleagues and even physicians extenders who do not have to be physicians to take care of these patients. The monitoring of patients on this treatment will also be a lot simpler and a lot less expensive, because is so safe we may not have to see the patients and do so many blood test and that can really save a lot of money.

　　《国际肝病》：目前已有多种DAA获得美国食品与药物管理局（FDA）批准上市。您如何看DAA的未来前景?

　　Mindie H. Nguyen教授：DAA是个历史性突破，在丙肝治疗史上具有里程碑意义。对于丙肝患者而言，DAA无疑给他们带来了福音，因为之前丙肝患者饱受干扰素和利巴韦林毒副作用的困扰，而且最后只有一半患者可以治愈。很多已诊断的患者因为害怕服用这些药物，或者医生犹豫是否开始应用这些药物，而迟迟未能接受治疗。而DAA只是一片药，很多DAA为两种药的复合制剂，治愈率达90%以上，这些都表明DAA是一种非常有效的药物。

　　Prof. Nguyen: As just you just said DAA really is a breakthrough. And is really a landmark in the treatment of hepatitis C. Is a wonderful thing for patients because in the past with interferon and ribavirin patients have to take very toxic medications that make them extremely sick for like a whole year, and at the end only half of them or less can be cured from the disease. So it is a very disappointing regimen. I think because of that, the vast majority of patients with hepatitis C still not diagnosed, and the diagnosed patients most of them are not treated because they are afraid to take those medicines and their doctors hesitate to start them on those medicines. So DAA is a pill and some of the DAA regimen now, only one pill that has two medications in it. It can cure patients more than ninety percent of the time. That is really very effective medication.

　　《国际肝病》：您认为DAA会取代现有疗法（干扰素／长效干扰素＋利巴韦林）吗？

　　Mindie H. Nguyen教授：我认为DAA将取代现有疗法，也希望如此。目前来看，DAA在全球范围内的施行还很局限，但我认为DAA的推广进展会很快，在未来的5～10年内将被广泛应用。同时，我们也希望DAA的价格更合理。

　　Prof. Nguyen:Yes, Ireally thinks so and I really hope so, for the sake of the patients. Right now the availability is still limited worldwide. But, I think that the progress is being made and is very fast. I think in the next five to ten years it will be widely available. And hopefully it will become much more affordable than it is now.