Newer direct-acting antivirals for hepatitis C virus infection

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.

Evaluation of five rapid diagnostic tests for detection of antibodies to hepatitis C virus (HCV): A step towards scale-up of HCV screening efforts in India

“…It has been estimated that the prevalence of HCV in India is between 0.5 and 1.5 per cent, but the majority of individuals remain undiagnosed [14]. Though a national serosurvey has not yet been conducted, it is hypothesized that there is wide variation in state-to-state prevalence.…”

“…Early diagnosis and curative treatment of HCV infection can reduce the risk of liver-related morbidity and mortality and also serve to prevent transmission of new infections [10–13]. Furthermore, availability of efficacious, well-tolerated, relatively cheap, and easy to administer directly acting antivirals (DAAs), offer an opportunity to provide treatment and management using a public health model in India [14]. The first step to scaling up access to curative HCV treatment is to identify individuals who are chronically infected with HCV.…”

Towards ending viral hepatitis as a public health threat: translating new momentum into concrete results in South-East Asia

“…Much has been accomplished in developing effective strategies and tools to prevent and treat viral hepatitis. In recent years, direct-acting antivirals have emerged for the treatment of hepatitis C, and persons who receive these treatments are cured up to 95% of the time [ 6 ]. Over the last 2 years, prices for these breakthrough regimens have plummeted, offering hope for much swifter progress to prevent HCV-related deaths (Fig.…”

Hepatitis C Virus (HCV) Infection: Screening, Diagnosis, Therapy and Prevention

“…7 Early diagnosis & therapy of infection related to HCV can minimize the possibility of disease of liver, mortality & check the spread of current infections. [8][9] . The initial stride in growing approach to HCV cure is for persons who are having HCV infection of chronic stage.…”