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Newer direct-acting antivirals for hepatitis C virus infection: Perspectives for India
Varun Gupta1, Ashish Kumar1, Praveen Sharma1
1Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India.
Insights
Direct-acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment, offering high cure rates and better tolerability. Sofosbuvir-based strategies are key for managing HCV genotypes 3 and 1 in India, including cirrhosis.
Area of Science:
- Hepatology
- Virology
- Pharmacology
Background:
- Chronic hepatitis C virus (HCV) infection affects 170-200 million globally, causing significant mortality and healthcare costs, particularly in India.
- HCV treatment evolved from interferon (IFN)-based therapies to pegylated-IFN (PEG-IFN) and ribavirin (RBV), with improved tolerability.
- Direct-acting antivirals (DAAs) represent a revolutionary advancement in HCV treatment, targeting virus-specific proteins.
Purpose of the Study:
- To review direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection.
- To discuss the role of sofosbuvir (SOF) in various HCV genotypes and liver disease stages.
- To propose SOF-based treatment strategies for prevalent Indian HCV genotypes (3 and 1) and cirrhosis.
Main Methods:
- Review of existing literature on direct-acting antivirals (DAAs) for hepatitis C virus (HCV).
- Focus on sofosbuvir (SOF) efficacy, tolerability, and application in different HCV genotypes.
- Development of treatment strategies incorporating SOF for genotype 3, genotype 1, and cirrhosis.
Main Results:
- Direct-acting antivirals (DAAs) achieve high HCV cure rates with reduced treatment durations and excellent patient tolerability.
- Sofosbuvir (SOF) is a highly effective DAA, crucial for HCV management in India due to its availability at a compassionate price.
- SOF-based regimens are being adopted in India, particularly for prevalent genotypes 3 and 1, and in patients with cirrhosis.
Conclusions:
- Direct-acting antivirals (DAAs), especially sofosbuvir (SOF), have transformed chronic hepatitis C virus (HCV) treatment globally and in India.
- SOF-based management strategies offer a highly effective and well-tolerated option for HCV genotypes 3 and 1, including cirrhotic patients.
- Further development of SOF-based treatment protocols is essential for optimizing HCV care in India.
Abstract:
Approximately three per cent of the world's population (170-200 million people) is chronically infected with hepatitis C virus (HCV) and almost 500,000 people die each year (mostly in lower middle-income countries) from complications secondary to HCV infection. In India, HCV infection imposes a considerable burden of mortality, morbidity and healthcare costs. In the last two decades, the treatment of HCV has evolved from interferon (IFN)-based therapies with or without ribavirin (RBV) to pegylated-IFN (PEG-IFN) and RBV-based therapies that were better tolerated by patients. However, the introduction of oral drugs, which specifically target virus-specific proteins, has now revolutionized the treatment of chronic HCV. These agents are known as direct-acting antivirals (DAAs). These drugs have resulted in very high HCV cure rates even with reduced treatment duration and an excellent tolerability by the patients compared to PEG-IFN- and RBV-based therapies. In India, sofosbuvir (SOF), one of the most effective DAAs, has been made available at a compassionate price; thus only those DAA-based management strategies, which contain SOF are adopted in India. Here, we review different DAAs and their possible roles in different genotypes and stages of liver disease, stressing upon the role of SOF. An attempt has also been made to devise strategies using SOF for the most prevalent genotypes in our country (genotypes 3 and 1) and cirrhosis.
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