Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Jul;30(4):423-33.
doi: 10.3904/kjim.2015.30.4.423. Epub 2015 Jun 29.

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

Seng Gee Lim  1 , Yock Young Dan  2
Affiliations
Review

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

Seng Gee Lim et al. Korean J Intern Med. 2015 Jul.

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.

Keywords: Asia; Cost-effectiveness; Hepatitis C; Roadmap strategy.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1. A 2015 roadmap for the treatment of genotype 1 (GT1) hepatitis C virus (HCV) infections in Asia. Modified from Lim [42], European Association for the Study of the Liver [11], and Manns et al. [22]. P, pegylated interferon; R, ribavirin; DAA, direct-acting antiviral; SOF, sofosbuvir; SVR, sustained virologic response; Abbvie 3D, mbitasvir, paritaprevir, ritonavir, and dasabuvir; SIM, simeprevir; LDV, ledipasvir; DCV, daclatasvir; RBV, ribavirin; ASN, asuneprevir. aFor treatment-experienced patients with cirrhosis; bFor patients with advanced cirrhosis with low platelets.
Figure 2
Figure 2. A 2015 roadmap for the treatment of genotype 3 (GT3) hepatitis C virus (HCV) infections in Asia. Based on European Association for the Study of the Liver [11], Andriulli et al. [26], and Cheinquer et al. [31]. P, pegylated interferon; R, ribavirin; DAA, direct-acting antiviral; SVR, sustained virologic response; SOF, sofosbuvir; DCV, daclatasvir; RBV, ribavirin. aTreatment-experienced patients with cirrhosis.
See this image and copyright information in PMC

References

    1. Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011;17:107–115. - PubMed
    1. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57:1333–1342. - PubMed
    1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. - PMC - PubMed
    1. International Monetary Fund. Download entire World Economic Outlook database [Internet] Washington (DC): International Monetary Fund; 2015. [cited 2015 Apr 22]. Available from: http://www.imf.org/external/pubs/ft/weo/2015/01/weodata/download.aspx.
    1. Institute for Health Metrics and Evaluation. Global Burden Of Diseases, Injuries And Risk Factors Study Operations Manual [Internet] Seattle (WA): Institute for Health Metrics and Evaluation; c2015. [cited 2015 Apr 23]. Available from: http://www.globalburden.org.