Korean J Intern Med.  2015 Jul;30(4):423-433. 10.3904/kjim.2015.30.4.423.

A 2015 roadmap for the management of hepatitis C virus infections in Asia

• Lim SG
• Dan YY

• KMID: 2366001
• DOI: http://doi.org/10.3904/kjim.2015.30.4.423

Abstract

The prevalence of hepatitis C virus (HCV) in Asia is 0.5% to 4.7%, with three different genotypes predominating, depending on the geographic region: genotype 1b in East Asia, genotype 3 in South and Southeast Asia, and genotype 6 in Indochina. Official approval for direct-acting antiviral agents (DAAs) in Asia lags significantly behind that in the West, such that in most countries the mainstay of therapy is still pegylated interferon and ribavirin (PR). Because the interleukin-28B genetic variant, associated with a high sustained virologic response (SVR), is common in Asians, this treatment is still acceptable in Asian patients with HCV infections. A roadmap for HCV therapy that starts with PR and takes into account those DAAs already approved in some Asian countries can provide guidance as to the best strategies for management, particularly of genotype 1 and 3 infections, based on SVR rates. Sofosbuvir and PR are likely to be the initial therapies for genotype 1 and 3 disease, although in the former these drugs may be suboptimal in patients with cirrhosis (62% SVR) and the extension of treatment to 24 weeks may be required. For difficult to treat genotype 3 infections in treatment-experienced patients with cirrhosis, a combination of sofosbuvir and PR result in an 83% SVR and is, therefore, currently the optimal treatment regimen. Treatment failure is best avoided since data on rescue therapies for DAA failure are still incomplete.

Keyword

Hepatitis C; Asia; Cost-effectiveness; Roadmap strategy

MeSH Terms

Antiviral Agents/adverse effects/*therapeutic use
Asia/epidemiology
Drug Therapy, Combination
Genotype
Hepacivirus/*drug effects/genetics
Hepatitis C/diagnosis/*drug therapy/epidemiology/genetics
Humans
Interleukins/genetics
National Health Programs
Practice Guidelines as Topic
Prevalence
Time Factors
Treatment Outcome
Antiviral Agents
Interleukins