Puri Pankaj, Anand Anil C, Saraswat Vivek A, Acharya Subrat K, Sarin Shiv K, Dhiman Radha K, Aggarwal Rakesh, Singh Shivaram P, Amarapurkar Deepak, Arora Anil, Chhabra Mohinish, Chetri Kamal, Choudhuri Gourdas, Dixit Vinod K, Duseja Ajay, Jain Ajay K, Kapoor Dharmesh, Kar Premashis, Koshy Abraham, Kumar Ashish, Madan Kaushal, Misra Sri P, Prasad Mohan V G, Nagral Aabha, Puri Amarendra S, Jeyamani R, Saigal Sanjiv, Shah Samir, Sharma Praveen K, Sood Ajit, Thareja Sandeep, Wadhawan Manav
Department of Gastroenterology, Army Hospital (R & R), New Delhi 110010, India.
Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi 110076, India.
J Clin Exp Hepatol. 2014 Jun;4(2):117-40. doi: 10.1016/j.jceh.2014.06.001. Epub 2014 Jun 24.
The estimated prevalence of hepatitis C virus (HCV) infection in India is between 0.5 and 1.5% with hotspots showing much higher prevalence in some areas of northeast India, in some tribal populations and in certain parts of Punjab. Genotype 3 is the most prevalent type of infection. Recent years have seen development of a large number of new molecules that are revolutionizing the treatment of hepatitis C. Some of the new directly acting agents (DAAs) like sofosbuvir have been called game-changers because they offer the prospect of interferon-free regimens for the treatment of HCV infection. These new drugs have not yet been approved in India and their cost and availability is uncertain at present. Till these drugs become available at an affordable cost, the treatment that was standard of care for the whole world before these newer drugs were approved should continue to be recommended. For India, cheaper options, which are as effective as the standard-of-care (SOC) in carefully selected patients, are also explored to bring treatment within reach of poorer patients. It may be prudent to withhold treatment at present for selected patients with genotype 1 or 4 infection and low levels of fibrosis (F1 or F2), and for patients who are non-responders to initial therapy, interferon intolerant, those with decompensated liver disease, and patients in special populations such as stable patients after liver and kidney transplantation, HIV co-infected patients and those with cirrhosis of liver.
据估计，印度丙型肝炎病毒（HCV）感染率在0.5%至1.5%之间，在印度东北部的一些地区、部分部落人群以及旁遮普邦的某些地区等热点地区，感染率要高得多。基因3型是最常见的感染类型。近年来，大量新型药物不断研发出来，正在彻底改变丙型肝炎的治疗方式。一些新型直接抗病毒药物（DAAs），如索磷布韦，被称为改变游戏规则的药物，因为它们为丙型肝炎病毒感染的治疗提供了无需使用干扰素治疗方案的前景。这些新药尚未在印度获批，目前其成本和可及性尚不确定。在这些药物能够以可承受的成本获得之前，在这些新药获批之前全球的标准治疗方法应继续被推荐使用。对于印度而言，也在探索在精心挑选的患者中与标准治疗（SOC）同样有效的更廉价选择，以使贫困患者能够接受治疗。目前，对于基因型1或4感染且纤维化程度较低（F1或F2）的特定患者、初始治疗无反应者、不耐受干扰素者、失代偿性肝病患者以及肝移植和肾移植后病情稳定的患者、合并感染HIV的患者以及肝硬化患者等特殊人群中的患者，暂不进行治疗可能是明智的做法。
