Treatment of chronic hepatitis C in Asia: When East meets West

Abstract

The issue of best treatment for chronic hepatitis C virus (HCV) infection is in constant flux, not only in Western countries but also in Asia. Currently, pegylated-interferon plus ribavirin is the standard of care. Studies from Asia provide evidence to support the same broad treatment strategies for Asian patients as recommended in Western countries. Nevertheless, there is increasing evidence that Asians have a higher likelihood of achieving a sustained virological response (SVR) than their Caucasians counterparts when treated with the corresponding regimen. With the recommended 'standard dose and duration treatment regimens', SVR is achieved in Asia for around 70% of HCV genotype 1 (HCV-1) infected cases,~90% of HCV-2/3,~65% of HCV-4, and 80% of HCV-6 patients. Difference of body weight in race might contribute the superior response in Asian patients. HCV genotype distribution in Asia also differs from North-America/Europe. HCV-6 and its variants, previously mistyped as HCV-1, needs accurate genotyping. Increasing data support the proposal that HCV genotype, baseline viral load and on-treatment virological response provide information for decision-making so that treatment can be individualized. Beyond the older recommendations, an abbreviated 24-week regimen could be suggested for HCV-1/4 patients with baseline viral loads < 400 000 IU/mL and a rapid virological response (RVR, HCV RNA undetectable at week 4), and an abbreviated 12-16 weeks of pegylated-interferon with weight-based doses of ribavirin could be suggested for HCV-2/3 patients with a RVR. Such tailored treatment regimens can reduce the costs of treatment and incidence of adverse events without compromising efficacy.Hepatitis C virus (HCV) infection is one of the most important causes of cirrhosis worldwide, and particularly in some countries of Asia (notably Japan) where it is now more prevalent than chronic hepatitis B virus infection. Hepatitis C virus infection can also lead to hepatocellular carcinoma (HCC). It is estimated that there are more than 170 million people chronically infected with HCV, and 3 to 4 million persons are newly infected each year.1 The risk for developing cirrhosis 20 years after initial HCV infection among those chronically infected varies between studies, but is estimated at around 10%-15% for men and 1-5% for women. 2Once cirrhosis is established, the rate of developing HCC is at 1%-4% per year. Approximately 280 000 deaths per year are related to HCV infection.1 Hepatitis C virus-related end-stage liver disease and HCC have become the leading cause for liver transplantation worldwide. 3 In the Asia-Pacific area, the estimated prevalence of antibodies to HCV (anti-HCV) range from 0.3% in New Zealand to 5.6% in Thailand. [3][4][5] In Japan, Middle East, Vietnam and Taiwan, several HCV hyper-endemic areas have been reported with an anti-HCV prevalence rate of 12% to as high as 58%. 3,6 In addition to the well-known endemic status of HBV infection in most countries of the Asia-Pacific region, HCV infection presents...

Epidemiology, Responses, and Way Forward

“…Patients with HCV genotypes 1, 4, and 6 should receive 48 weeks of treatment, while genotypes 2 and 3 should receive 24 weeks of treatment. 72,89 The goal of HCV treatment is to achieve a sustained virological response (SVR) which is confirmed with HCV RNA PCR being undetectable at 6 months after treatment completion. During the treatment, the effectiveness is assessed using the following categories to predict a successful SVR.…”

“…In contrast, if the patient is eligible for HAART using the general criteria, HAART should be initiated first and then HCV treatment should be initiated after the stabilization of the immune system to ensure treatment efficacy and to minimize the adverse events. 60,89,90 …”

“…During the treatment, the effectiveness is assessed using the following categories to predict a successful SVR. 72,89 rapid virological response, undetectable HCV RNA after 4 weeks of treatment; complete early virological response, undetectable HCV RNA after 12 weeks of therapy; partial early virological response, HCV RNA decreases at least 2 logs from the baseline after 12 weeks of therapy.…”

A Follow-up Study for Chinese Chronic Hepatitis C Patients Treated with the Combination of PEG-IFNα-2a (PEGASYS) and Ribavirin

“…[7][8][9][10] Host factors are common, including age, weight, base-line ALT or AST level, alcohol-intake history, route of transmission, time of transmission, adiposis hepatica or HIV-infected concomitant or not and compliance. Virological factors are also frequent, such as genotypes, viral load and liver fibrosis, etc.…”

Treatment Uptake of Patients with Chronic Hepatitis C: Can We Expect and Do More?

“…With the current SOC regimen, the sustained virological response (SVR) rates in Western countries were 42-60% [3,5,6] and 76-95% [3,6,7] for genotype 1 and 2/3 patients, respectively. The response to the recommended regimens has been observed to be substantially higher in Asian countries [8]. To maximize SVR rates by using the on-treatment viral kinetics [rapid virologic response (RVR): HCV RNA seronegative by PCR (\50 IU/ml) at week 4 and early virologic response (EVR): HCV RNA seronegative or decline more than two logs from baseline at week 12] is the major advance of therapy for CHC.…”