Khaliq Saba, Raza Syed Mohsin
Department of Physiology and Cell Biology, University of Health Sciences, Lahore 54600, Pakistan.
Institute of Biomedical and Allied Health Sciences, University of Health Sciences, Lahore 54600, Pakistan.
Medicina (Kaunas). 2018 Nov 5;54(5):80. doi: 10.3390/medicina54050080.
In Pakistan, the burden of the hepatitis C virus (HCV) infection is the second highest in the world with the development of chronic hepatitis. Interferon-based combination therapy with ribavirin was the only available treatment until a few years back, with severe side-effects and high failure rates against different genotypes of HCV. Interferon-free all-oral direct-acting antiviral agents (DAAs) approved by the FDA have revolutionized the HCV therapeutic landscape due to their efficiency in targeting different genotypes in different categories of patients, including treatment naïve, treatment failure and relapsing patients, as well as patients with compensated and decompensated cirrhosis. The availability and use of these DAAs is limited in the developing world. Sofosbuvir (SOF), a uridine nucleotide analogue and inhibitor of HCV encoded NS5B polymerase, is now a widely available and in-use DAA in Pakistan; whereas daclatasvir was recently added in the list. According to the documented results, there is hope that this disease can be effectively cured in Pakistan, although a few concerns still remain. The aim of this article is to review the effectiveness of DAAs and the current status of this treatment against HCV genotype 3 infection in Pakistan; various factors associated with SVR; its limitations as an effective treatment regime; and future implications.
在巴基斯坦，丙型肝炎病毒（HCV）感染负担在全球位列第二，且会发展为慢性肝炎。直到几年前，基于干扰素与利巴韦林的联合疗法是唯一可用的治疗方法，但该疗法副作用严重，对不同基因型HCV的治疗失败率高。美国食品药品监督管理局（FDA）批准的无干扰素全口服直接抗病毒药物（DAA）彻底改变了HCV治疗格局，因为它们能有效针对不同类别患者的不同基因型，包括初治患者、治疗失败和复发患者，以及代偿期和失代偿期肝硬化患者。在发展中国家，这些DAA的可及性和使用情况有限。索磷布韦（SOF）是一种尿苷核苷酸类似物，也是HCV编码的NS5B聚合酶抑制剂，目前在巴基斯坦是一种广泛可及且正在使用的DAA；而达卡他韦最近也被列入其中。根据已记录的结果，尽管仍存在一些问题，但在巴基斯坦，这种疾病有望得到有效治愈。本文旨在综述DAA的有效性以及巴基斯坦针对HCV 3型感染的当前治疗现状；与持续病毒学应答（SVR）相关的各种因素；其作为有效治疗方案的局限性；以及未来的影响。
