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Urgency to treat patients with chronic hepatitis C in Asia
Jia-Horng Kao1, Sang Hoon Ahn2, Rong-Nan Chien3
1National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Chronic hepatitis C (CHC) affects millions globally, with most cases in Asia. While direct-acting antivirals (DAAs) show promise, access to these advanced treatments in Asian countries remains a significant challenge due to cost.
Area of Science:
- Hepatology and Viral Gastroenterology
- Global Public Health
- Infectious Diseases
Background:
- Chronic hepatitis C (CHC) is a significant global health concern, particularly prevalent in Central, South, and East Asia.
- Hepatitis C virus (HCV) genotypes 1b, 2, 3, and 6 are most common in Asia, where over half of the world's HCV patients reside.
- While Asian patients historically respond better to interferon (IFN)-based therapies, these treatments have limitations in efficacy and safety.
Purpose of the Study:
- To review the current landscape of CHC treatment in Asia.
- To highlight the efficacy and accessibility challenges of direct-acting antivirals (DAAs) in the region.
- To emphasize the need for improved HCV management strategies and equitable access to advanced therapies.
Main Methods:
- Review of existing literature on CHC prevalence, genotypes, and treatment outcomes in Asia.
- Analysis of the efficacy, safety, and tolerability of interferon-based therapies and direct-acting antivirals (DAAs).
- Discussion of real-world data needs and challenges in DAA accessibility in Asian healthcare systems.
Main Results:
- Direct-acting antivirals (DAAs) demonstrate superior virologic outcomes and tolerability compared to older therapies.
- Despite clinical trial successes, real-world data on DAAs in Asia is limited.
- Significant economic barriers hinder access to DAA regimens for many patients in Asian countries.
Conclusions:
- HCV eradication is achievable with modern treatments, but equitable access in Asia is impeded by economic factors.
- Continued research into real-world DAA effectiveness and cost-effectiveness is crucial for Asian populations.
- Enhanced screening, awareness, and prevention programs are necessary alongside improved treatment accessibility for optimal HCV management in Asia.
Abstract:
Chronic hepatitis C (CHC) infection poses a global healthcare burden, being associated with serious complications if untreated. The prevalence of hepatitis C virus (HCV) infection is highest in areas of Central, South, and East Asia; over 50% of HCV patients worldwide live in the region, where HCV genotypes 1b, 2, 3, and 6 are the most prevalent. Treatment outcomes for chronic hepatitis C vary by ethnicity, and Asian patients achieve higher sustained virologic response rates following interferon (IFN)-based therapy than non-Asians. However, low efficacy, poor safety profile, and subcutaneous administration limit the use of IFN-based therapies. Superior virologic outcomes have been observed with different classes of direct-acting antivirals (DAAs) alone or in combination, and several all-oral DAA regimens are available in Asia. These regimens have shown excellent efficacy and favorable tolerability in clinical trials, yet there is a need for further studies of DAAs in a real world context, particularly in Asia. Furthermore, IFN-free treatment may not be accessible for many patients in the region, and IFN-based regimens remain an option in some countries. There is a need to improve current clinical practices for HCV management in Asia, including effective screening, disease awareness, and prevention programs, and to further understand the cost-effectiveness of IFN-free regimens. The evolution of potent treatments makes HCV eradication a possibility that should be available to all patients. However, access to these therapies in Asian countries has been slow, primarily because of economic barriers that continue to present a hurdle to optimal treatment.
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