Management of chronic hepatitis C in 2017

Abstract

Hepatitis C virus (HCV) represents one of the most common aetiologies of chronic liver disease and causes a major global health burden. Globally an estimated 80 million people are chronically infected, but the majority of whom is still undiagnosed. Prior to the discovery of the virus in 1989 a significant number of patients were exposed and consecutively infected with HCV via contaminated transfusions, as it is a blood-borne disease. Chronic HCV infection pursues a progressive course that ultimately results in the development of cirrhosis, liver failure and hepatocellular carcinoma (HCC), if left untreated. The efficiency and tolerability of therapeutical approaches improved considerably with the development of direct-acting antivirals (DAA). The majority of patients treated with the recommended DAA combinations can be cured, which is reflected in achievement of sustained virological response (SVR). This review is intended to provide guidance in the management of patients with chronic hepatitis C, including recommendations for adequate screening, diagnostic procedures, clinical care, treatment and follow-up strategies.

Daclatasvir-Sofosbuvir Combination Therapy with or without Ribavirin for Hepatitis-C Virus Infection: An Experience from a Tertiary Care Hospital, Pakistan

“…Our findings correlate with the recent phase 3 trials done, which showed that DAA therapy achieved Daclatasvir-Sofosbuvir Combination Therapy Pak Armed Forces Med J 2023; 73(5): 1520 high SVR rates (more than 90% for genotype-1, 80-90% for genotype-2, 60-70% for genotype-3) for compensated cirrhotic patients, with high tolerance & relatively low rates of adverse effects. 15 In our study, genotype 3(81.3%) was more common, followed by genotype 1(11.8%), with few cases of 2(1.7%) and mixed genotype (5.1%) respectively, when compared to other studies in which genotype 4 cases were also reported. 16,17 In this study, 89.83% of naïve cases while only 10.2% had a previous history of HCV treatment with an interferon based regime, among which 3.38% showed treatment failure and 6.7% relapses.…”

Diagnostic Value of Serum Biomarkers for Patients Undergoing Curative Resection with Non-B, Non-C Hepatocellular Carcinoma

“…The morbidity of virus-related hepatocellular carcinoma (HCC) has been decreasing worldwide because of vaccination, antiviral therapy, and screening of transfused blood. [1][2][3] Nevertheless, HCC is still one of the main leading causes of cancer-related death worldwide. 4 One reason may be that the morbidity of non-B, non-C (NBNC) HCC, which is negative for the hepatitis-B surface antigen (HBsAg) and hepatitis-C (HCV) antibody, has been increasing continuously.…”

Risk Factors Contributing to the Occurrence and Recurrence of Hepatocellular Carcinoma in Hepatitis C Virus Patients Treated with Direct-Acting Antivirals

“…Hepatitis C virus (HCV) is a single-stranded RNA virus that targets hepatocytes and a member of the Flaviviridae family [1]. HCV represents one of the most common causes of chronic liver disease and, therefore, represents a major global public health problem [2]. HCV causes debilitating liver disease, which may progress to cirrhosis and cancer, and claims 500,000 lives annually worldwide [3].…”

“…Various authors consider the sudden decrease in viral load achieved with DAAs as a cause of distortion in the immune system [8]. As previously mentioned, a multistep process of HCV-induced hepatocarcinogenesis consists of a combination of pathway alterations caused either directly by viral factors or by the effect of immune mediators as a consequence of chronic inflammation, as shown in Figure 1 [2].…”