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Identifying Gaps in the Treatment Guidelines for Hepatitis C in Peru to Meet International Standards: A Narrative
Jose A Gonzales-Zamora1,2, Carlos Quispe-Vicuña3, Martín E Reategui-Garcia4
1Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Insights
Peruvian Hepatitis C guidelines require urgent updates to incorporate new direct-acting antivirals and treatment strategies. Current guidelines lag behind international standards, impacting patient care and disease control in Peru.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health Policy
Background:
- Hepatitis C virus (HCV) remains a significant global health burden.
- Existing Peruvian practice guidelines for HCV management are over five years old.
- Recent advancements in antiviral therapies necessitate guideline revision.
Purpose of the Study:
- To compare current Peruvian HCV guidelines with international recommendations.
- To identify critical discrepancies in treatment protocols.
- To advocate for the standardization and updating of Peruvian HCV guidelines.
Main Methods:
- Review of recent international HCV treatment guidelines (WHO, American, European).
- Comparative analysis of international recommendations against existing Peruvian national guidelines.
- Identification of specific differences in therapeutic approaches.
Main Results:
- Peruvian guidelines do not include Glecaprevir/Pibrentasvir as a first-line therapy, unlike WHO, American, and European recommendations.
- Management of chronic kidney disease patients with direct-acting antivirals, including Sofosbuvir-based regimens, is not aligned with international practices in Peru.
- Significant divergence exists in recommended treatment strategies.
Conclusions:
- Updating Peruvian national guidelines for Hepatitis C is imperative to align with global standards.
- Incorporating new direct-acting antivirals and therapeutic strategies is crucial for improved patient outcomes.
- Cost-effectiveness analysis is recommended to facilitate the implementation of novel antivirals in Peru.
Abstract:
Hepatitis C virus still represents a major cause of morbidity and mortality worldwide. In Peru, two national practice guidelines for the management of this infection were published more than 5 years ago; however, the latest breakthroughs in the treatment make it necessary to update these guidelines. We reviewed the most recent recommendations of the international guidelines and compared them with the current Peruvian guidelines. We found major differences, such as the use of Glecaprevir/Pibrentasvir as a first-line therapy, which is contemplated in the World Health Organization guideline, and recommended by American and European guidelines, but is not considered in the Peruvian guidelines. Another crucial difference lies in the management of patients with chronic kidney disease, who are treated nowadays with a variety of direct-acting antivirals, with no restrictions on the use of Sofosbuvir-based regimens in first-world countries, an approach that has not been adopted in Peru. We believe that standardization of the recommendations of the Peruvian guidelines is imperative, including the new therapeutic strategies that have emerged in recent years. We also suggest conducting a cost effectiveness analysis in the Peruvian context to allow for the implementation of new antivirals, and to achieve a better control of hepatitis C in the country.
