Ali Muhammad, Afzal Samia, Zia Asad, Hassan Ahmed, Khalil Ali Talha, Ovais Muhammad, Shinwari Zabta Khan, Idrees Muhammad
Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad Division of Molecular Virology, National Center of Excellence in Molecular Biology (CEMB) Center for Applied Molecular Biology (CAMB), University of the Punjab, Lahore Hazara University Mansehra, Mansehra, Pakistan.
Medicine (Baltimore). 2016 Dec;95(50):e5327. doi: 10.1097/MD.0000000000005327.
The estimated hepatitis C virus (HCV) carriers are approximately 10 million in Pakistan which usually progresses to chronic hepatitis, with rare cases of spontaneous viral eradication. The present article reviews the treatment status of HCV infection in Pakistani population and various factors associated with the treatment response rates.
Literature on anti-HCV therapy was searched in PubMed, Google Scholar and PakMediNet. Thirty three different studies representing different geographic regions of Pakistan published from 2002 to 2016 were included in the present review. Weighted mean, standard error estimates (SE) and standard deviation (SD) were determined for each population group.
Mean value for sustained virological response (SVR) for standard IFN plus ribavirin (RBV) combination therapy was 68.38% ± 14.13% (range 33.8%-87.10%; SE 3.08) and pegylated-IFN plus RBV combination therapy 64.38% ± 8.68% (range 55.0%-76.00%; SE 3.88). The lowest value for SVR has been reported to be 24.3% (for genotype 1; administering INF-α 2b 3MU 3 times/week and RBV 1000-1200 mg/day for 48 weeks) while highest of 87.5% (genotype 3a; INF-α 2a 3MU 3 times/week and RBV 1000-1200 mg/day for 24 weeks). The mean value for rapid virological response (RVR) was found to be 48.18% ± 29.20% (SE 9.73). As PEG-interferon and direct acting antivirals (DAAs) are relatively expensive, interferon-alfa (IFN-α) and RBV combination therapy have been used widely to treat HCV infected patients in Pakistan for the last one and half decade. On average, 2.45% of the patients discontinued treatment due to severe side effects.
We encourage further studies on understanding host and viral factors associated with specific focus on harder to treat viral variants (relapsers and nonresponders). These variants are currently rising in the country.
据估计，巴基斯坦有大约1000万丙型肝炎病毒（HCV）携带者，这些携带者通常会发展为慢性肝炎，很少有病毒自发清除的病例。本文综述了巴基斯坦人群中HCV感染的治疗现状以及与治疗反应率相关的各种因素。
在PubMed、谷歌学术和PakMediNet上检索了关于抗HCV治疗的文献。本综述纳入了2002年至2016年发表的代表巴基斯坦不同地理区域的33项不同研究。确定了每个群体的加权平均值、标准误差估计值（SE）和标准差（SD）。
标准干扰素加利巴韦林（RBV）联合治疗的持续病毒学应答（SVR）平均值为68.38%±14.13%（范围33.8%-87.10%；SE 3.08），聚乙二醇化干扰素加RBV联合治疗为64.38%±8.68%（范围55.0%-76.00%；SE 3.88）。据报道，SVR的最低值为24.3%（基因型1；每周3次给予INF-α 2b 3MU，RBV 1000-1200mg/天，持续48周），最高值为87.5%（基因型3a；每周3次给予INF-α 2a 3MU，RBV 1000-1200mg/天，持续24周）。快速病毒学应答（RVR）的平均值为48.18%±29.20%（SE 9.73）。由于聚乙二醇干扰素和直接作用抗病毒药物（DAAs）相对昂贵，在过去十五年里，干扰素-α（IFN-α）和RBV联合治疗在巴基斯坦被广泛用于治疗HCV感染患者。平均而言，2.45%的患者因严重副作用而停药。
我们鼓励进一步开展研究，以了解宿主和病毒因素，尤其关注更难治疗的病毒变异体（复发者和无应答者）。目前，这些变异体在该国呈上升趋势。
