Management of hepatitis C virus infection in the Asia-Pacific region: an update.

Abstract

The Asia-Pacific region has disparate hepatitis C virus (HCV) epidemiology, with prevalence ranging from 0·1% to 4·7%, and a unique genotype distribution. Genotype 1b dominates in east Asia, whereas in south Asia and southeast Asia genotype 3 dominates, and in Indochina (Vietnam, Cambodia, and Laos), genotype 6 is most common. Often, availability of all-oral direct-acting antivirals (DAAs) is delayed because of differing regulatory requirements. Ideally, for genotype 1 infections, sofosbuvir plus ledipasvir, sofosbuvir plus daclatasvir, or ombitasvir, paritaprevir, and ritonavir plus dasabuvir are suitable. Asunaprevir plus daclatasvir is appropriate for compensated genotype 1b HCV if baseline NS5A mutations are absent. For genotype 3 infections, sofosbuvir plus daclatasvir for 24 weeks or sofosbuvir, daclatasvir, and ribavirin for 12 weeks are the optimal oral therapies, particularly for patients with cirrhosis and those who are treatment experienced, whereas sofosbuvir, pegylated interferon, and ribavirin for 12 weeks is an alternative regimen. For genotype 6, sofosbuvir plus pegylated interferon and ribavirin, sofosbuvir plus ledipasvir, or sofosbuvir plus ribavirin for 12 weeks are all suitable. Pegylated interferon plus ribavirin has been replaced by sofosbuvir plus pegylated interferon and ribavirin, and all-oral therapies where available, but cost and affordability remain a major issue because of the absence of universal health coverage. Few patients have been treated because of multiple barriers to accessing care. HCV in the Asia-Pacific region is challenging because of the disparate epidemiology, poor access to all-oral therapy because of availability, cost, or regulatory licensing. Until these problems are addressed, the burden of disease is likely to remain high.

• Authors: Seng Gee Lim, Alessio Aghemo, Pei-Jer Chen, Yock Young Dan, Edward Gane, Rino Gani, Robert G Gish, Richard Guan, Ji Dong Jia, Kieron Lim, Teerha Piratvisuth, Samir Shah, Mitchell L Shiffman, Frank Tacke, Soek Siam Tan, Tawesak Tanwandee, Khin Maung Win, Cihan Yurdaydin
• Journal: The lancet. Gastroenterology & hepatology (Lancet Gastroenterol Hepatol) Vol. 2 Issue 1 Pg. 52-62 (01 2017) ISSN: 2468-1253 [Electronic] Netherlands
• PMID: 28404015 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2017 Elsevier Ltd. All rights reserved.

Chemical References

• Antiviral Agents

Topics

• Antiviral Agents (economics, supply & distribution, therapeutic use)
• Asia (epidemiology)
• Coinfection
• Cost-Benefit Analysis
• Drug Costs
• Genotype
• HIV Infections (drug therapy)
• Health Services Accessibility
• Hepatitis C (complications, drug therapy, epidemiology, genetics)
• Humans
• Liver Cirrhosis (complications)
• Pacific Islands (epidemiology)
• Prevalence
• Risk Factors
• Treatment Failure