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Year : 2016  |  Volume : 34  |  Issue : 3  |  Page : 273--274

Treatment for hepatitis C virus infection in India: Promising times

P Abraham 
 Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
P Abraham
Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu

How to cite this article:
Abraham P. Treatment for hepatitis C virus infection in India: Promising times.Indian J Med Microbiol 2016;34:273-274

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Abraham P. Treatment for hepatitis C virus infection in India: Promising times. Indian J Med Microbiol [serial online] 2016 [cited 2020 Aug 5 ];34:273-274
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Hepatitis C virus (HCV) infection is a major public health problem globally. An estimated 3% of the world's population is chronically infected with HCV. Up to 80% of the global HCV burden is found in low- and middle-income countries of North Africa, Middle East, East Asia and South-East Asia. [1] India alone has an estimated burden of 8.6 million viraemic HCV carriers. [2] Of these infected individuals, 20-30% will eventually develop cirrhosis or hepatocellular carcinoma. [3] In addition to instituting prevention strategies for acquisition of HCV infection, treatment of HCV-infected individuals is equally important to reduce the burden of infected individuals.

The overall treatment options have evolved over the past two decades, particularly in terms of yielding better response rates. Treatment of chronic hepatitis C infection started in the early 1990s with the use of recombinant interferon (IFN) alpha as monotherapy yielding dismal response rates. Response to antiviral treatment for HCV has been measured by looking for sustained viral response (SVR), i.e., HCV RNA negativity 6 months after stopping the recommended course of treatment. In the later 1990s, ribavirin was added to this therapy. This combination therapy was further improved on by the use of pegylated IFN (PEG-IFN) and ribavirin which brought the SVR rates to 40-50% with HCV genotype 1 and 80% with genotypes 2 and 3. Despite this, uptake of HCV treatment was low in most countries (1-5% of chronically infected individuals) due to long duration of therapy (24-48 weeks), significant side effects and cost.

In 2011, a new class of drugs called oral, direct-acting antivirals (DAAs) for HCV became available in some countries. Boceprevir and telaprevir which are NS3/4A protease inhibitors were used along with PEG-IFN and ribavirin, improving the SVR to about 75% with HCV genotype 1 infections. However, even before they could become available in India, they were stopped because they had a low genetic barrier to drug resistance and significant drug interactions with those who were also on antiretroviral therapy. Subsequently, simeprevir a newer NS3/4A protease inhibitor got licensed for use. With the development of more DAAs comprising at least three other classes of drugs: NS5A inhibitors such as ledipasvir and daclatasvir; NS5BRNA dependent RNA polymerase inhibitors comprising nucleoside/nucleotide analogues (NPIs) such as sofosbuvir and non-NNPIs such as dasabuvir, IFN-free treatment regimens have been made possible. With the use of these second-generation DAAs, SVR rates of over 90% have been reported. [4] Duration of treatment in uncomplicated cases of HCV-related chronic liver disease is 12 weeks.

The predominant genotypes of HCV in India are genotype 3, followed by genotype 1 and genotypes 4, 6 and 2 in small proportions. [5],[6] Generic versions of sofosbuvir, ledipasvir and daclatasvir have now become available in India, reducing the cost of therapy to a fraction of costs for treatment in developed countries. Combination therapy with ledipasvir and sofosbuvir or daclatasvir and sofosbuvir with or without ribavirin is much more affordable than the earlier treatment with PEG-IFN-based therapy which cost lakhs of Indian rupees. State governments are attempting to provide cost-free HCV treatment for economically disadvantaged patients and high prevalence settings. Future challenges will include the introduction of cost-effective, quality controlled laboratory testing throughout the country.

In summary, these are exciting and promising times in tackling the burden of HCV in India with more efficacious, pan genotypic, better tolerated, cheaper treatment having become available.

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Conflicts of interest

There are no conflicts of interest.


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