Abstract
BACKGROUND & OBJECTIVE: primary Hepatitis C is a serious public health problem and is the cause of liver cirrhosis, hepatocellular carcinoma (HCC), and numerous end-stage liver disease manifestations. The management of hepatitis C is to preclude liver cirrhosis, lessen the risk of hepatocellular carcinoma or hepatoma, and curing the extra hepatic diseases. Initially, interferon was the cornerstone for treating hepatitis C, but due to its cumbersome complications, route of administration, and limited treatment access, many patients showed noncompliance. New therapies for chronic hepatitis C have been introduced based on direct antiviral effects. Several genotypes of hepatitis C have been discovered and they are responsive to different antiviral therapies. Our objective was to assess the genotypic distribution of HCV in our local setup and their pattern of response to different combination of anti-viral therapies by assessing the sustained viral response (SVR) after 12 weeks post-treatment. To determine the most prevalent genotype of hepatics C virus in our population and pattern of the response of multiple genotypes to different antiviral regimens.
 METHODOLOGY: It is a cross-sectional study conducted for duration of six months and recruited those patients whose polymerase chain reaction (PCR) was found positive for hepatitis C virus at Islamabad Diagnostic Center. We analyzed 100 patients, both children and adults. Patients were assessed for different genotypes and then different combinations of antiviral treatments were administered. Their clinical data, hematological parameters and viral load before and after treatment were also analyzed.
 RESULTS: In a total of 100 positive hepatitis C virus-infected patients, 55% were females and 45% males. The frequencies of genotypes observed were 91 %, 06%, and 03% of genotype 3, 1a, and 1b respectively. 51 out of 91 patients with type 3 genotype, who were on antiviral therapy of sofosbuvir and ribavirin, all of them achieved SVR. 30 out of 91 patients with type 3 genotype were treated with sofosbuvir alone, the percentage of failure to achieve SVR in them was 6.7%. Treatment failure percentage of 10% was observed when a combination of Interferon (INF) alpha and ribavirin was used in type 3 genotype. Remaining six patients with type 1a and three patients of type 1b genotype achieved SVR with different regimens used.
 CONCLUSION: Although the increased load of HCV in our setup is an alarming situation the prevalence of type 3 genotype is a blessing in disguise. The success of sustained viral response after various combinations of direct antiviral therapy and interferon-free treatment is hope for the ultimate cure of the disease and avoidance of debilitating side effects related to interferon.
Highlights
In our study, a hundred patients who were found positive for the hepatitis C virus by Polymerase chain reaction were included
These patients were assessed for the sustained viral response (SVR) which is defined as the presence of sustained, undetectable Hepatitis C virus (HCV) RNA levels after at least 12 weeks of completing anti HCV therapy, using a sensitive assay
By analyzing the three observed genotypes separately, most of the patients were having genotype 3 (91%) and their response varied with different treatment regimens used. They were stratified according to the viral load before and after the antiviral therapy. 30 out of 91 patients (33%) with type 3 genotype were treated with sofosbuvir alone. 51(56%) were treated with sofosbuvir and ribavirin whe reas 10(12%) were treated with INF and ribavirin regimen (Figure-III)
Summary
Hepatitis C virus (HCV) infection has been revealed as one of the major health challenges with approximately 200 million infected people worldwide, making about 3.3 percent of the world population and is responsible for almost 350,000 deaths per annum . [1] One of the primary reasons for chronic liver disease is HCV and it is caused by a blood-borne virus, belonging to the family Flaviviridae . [2] The current leading risk factor for its transmission is injectable drug abuse and other potential modes of infection include work-related exposure, sexual transmission, unsafe injection use, transfusion of unscreened blood, intranasal cocaine use, tattooing, body piercing, and fetal-maternal transmission . [3] It is a well-recognized global health problem due to its progression to cirrhosis and hepatocellular carcinoma . [4] It is usually asymptomatic and chronic disease presenting often with complications. In patients with chronic HCV genotype 1b, there is more severe liver disease, METHODOLOGY: The study was conducted over 6months at Islamabad Diagnostic Center. Our objective was to assess the genotypic distribution of HCV in our local setup and their pattern of response to different combination of anti-viral therapies by assessing the sustained viral response (SVR) after 12 weeks post-treatment. Patients were assessed for different genotypes and different combinations of antiviral treatments were administered Their clinical data, hematological parameters and viral load before and after treatment were analyzed. The success of sustained viral response after various combinations of direct antiviral therapy and interferon-free treatment is hope for the ultimate cure of the disease and avoidance of debilitating side effects related to interferon.
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