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J Clin Exp Hepatol. 2014 Jun;4(2):117-40. doi: 10.1016/j.jceh.2014.06.001. Epub 2014 Jun 24.

Consensus Statement of HCV Task Force of the Indian National Association for Study of the Liver (INASL). Part II: INASL Recommendations for Management of HCV in India.

Author information

1
Department of Gastroenterology, Army Hospital (R & R), New Delhi 110010, India.
2
Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi 110076, India.
3
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical, Sciences, Lucknow, Uttar Pradesh 221016, India.
4
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
5
Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
6
Department of Hepatology, Postgraduate Institute of Medical Education and, Research, Chandigarh 160012, India.
7
Department of Gastroenterology, SCB Medical College, Cuttack, Odisha 753007, India.
8
Department of Gastroenterology, Bombay Hospital, Mumbai, Maharashtra 400020, India.
9
Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi 110060, India.
10
Department of Gastroenterology, Fortis Hospital, Mohali, Punjab 160047, India.
11
Department of Gastroenterology, International Hospital, Guwahati, Assam 781005, India.
12
Department of Gastroenterology, Fortis Hospital, Gurgaon, Haryana 122002, India.
13
Department of Gastroenterology, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India.
14
Department of Gastroenterology, Choithram Hospital & Research Centre, Indore, Madhya Pradesh 452014, India.
15
Department of Gastroenterology, Global Hospital, Hyderabad, Andhra Pradesh 500004, India.
16
Department of Gastroenterology, LNJP Hospital, and Maulana Azad Medical College, New Delhi 110002, India.
17
Department of Hepatology, Lakeshore Hospital, Cochin, Kerala 682304, India.
18
Department of Gastroenterology, Medanta Medicity, Gurgaon, Haryana 122001, India.
19
Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh 211001 India.
20
Department of Gastroenterology, VGM Hospital, Coimbatore, Tamil Nadu 641005, India.
21
Department of Gastroenterology, Jaslok Hospital, Mumbai, Maharashtra 400026, India.
22
Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
23
Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu 632004, India.
24
Department of Gastroenterology, Global Hospital, Mumbai, Maharashtra 400078, India.
25
Department of Medicine, Armed Forces Medical College, Pune, Maharashtra 411040, India.
26
Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab 141001, India.

Abstract

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.

KEYWORDS:

ALT, alanine amintraonsferase; ANC, absolute neutrophil count; AST, aspartate aminotransferase; CH–C, Chronic Hepatitis C; CKD, chronic kidney disease; CTP, Child-Turcotte-Pugh; EIA, enzyme immunoassay; ETR, end-of-treatment response; EVR, early virological response; GRADE, Grading of Recommendations Assessment, Development and Evaluation; HCV, hepatitis C virus; HIV, Human immunodeficiency virus; IFNa, interferon alfa; INASL, Indian National Association for Study of the Liver; PCR, polymerase chain reaction; Peg-IFNa, pegylated interferon alfa; RBV, Ribavirin; RVR, rapid virological response; SOC, standard of care; SVR, sustained virological response; ULN, upper limit of normal; anti-HCV, antibody to HCV; antiviral therapy; chronic hepatitis; hepatitis C virus

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