Abstract
In Pakistan, the burden of the hepatitis C virus (HCV) infection is the second highest in the world with the development of chronic hepatitis. Interferon-based combination therapy with ribavirin was the only available treatment until a few years back, with severe side-effects and high failure rates against different genotypes of HCV. Interferon-free all-oral direct-acting antiviral agents (DAAs) approved by the FDA have revolutionized the HCV therapeutic landscape due to their efficiency in targeting different genotypes in different categories of patients, including treatment naïve, treatment failure and relapsing patients, as well as patients with compensated and decompensated cirrhosis. The availability and use of these DAAs is limited in the developing world. Sofosbuvir (SOF), a uridine nucleotide analogue and inhibitor of HCV encoded NS5B polymerase, is now a widely available and in-use DAA in Pakistan; whereas daclatasvir was recently added in the list. According to the documented results, there is hope that this disease can be effectively cured in Pakistan, although a few concerns still remain. The aim of this article is to review the effectiveness of DAAs and the current status of this treatment against HCV genotype 3 infection in Pakistan; various factors associated with SVR; its limitations as an effective treatment regime; and future implications.
Highlights
Since its discovery in 1989, chronic hepatitis C virus (HCV) infections have become the most common global health problem, with current reports stating more than 71 million infected people worldwide [1]
The treatment options against hepatitis C have dramatically increased due to the development of IFN-free oral treatment regimen that directly acts on the HCV non-structural proteins, called direct-acting antiviral agents (DAAs)
The basic research on the HCV structure and replicative cycle has revolutionized the development of DAAs, resulting in an increase in the sustained virological response (SVR) rates from 40–50% to more than 95%
Summary
Since its discovery in 1989, chronic hepatitis C virus (HCV) infections have become the most common global health problem, with current reports stating more than 71 million infected people worldwide [1]. Program for Hepatitis B and C Control in Pakistan where the IFN-based treatment was used, viral clearance has been documented in only 67% of the infected population [9] This treatment regime was associated with troublesome side effects such as flu, fatigue, fever, and leucopenia or thrombocytopenia, leading to dose reduction or discontinuation of treatment [10,11]. The treatment options against hepatitis C have dramatically increased due to the development of IFN-free oral treatment regimen that directly acts on the HCV non-structural proteins, called direct-acting antiviral agents (DAAs) These DAAs have revolutionized the management of hepatitis C, as they are well-tolerated and achieve cure rates of over 90% regardless of liver fibrosis, prior response to IFN/RBV, gender, age, and race [12]. The data showed that the treatment response of oral regimens is promising with some concerns in the Pakistani population, where the predominant genotype is 3a
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
