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Liver Int. 2017 Feb;37(2):159-172. doi: 10.1111/liv.13272. Epub 2016 Nov 10.

The impact of hepatitis C virus outside the liver: Evidence from Asia.

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Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Liver Center, Saga University Hospital, Saga University, Saga, Japan.
Department of Gastroenterology, Liver Center, Asan Medical Center, Seoul, Korea.
Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
Department of Medicine, National University of Singapore, Singapore.
Costello Medical Singapore Pte Ltd, Singapore.
Division of Gastroenterology and Hepatology and Division of Clinical Pathology, University Hospital, Geneva, Switzerland.
Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.


Between 80 and 115 million people worldwide are chronically infected with hepatitis C virus, with 60%-90% of these being undiagnosed. Untreated chronic hepatitis C (CHC) is associated with progressive liver disease, cirrhosis, hepatocellular carcinoma and liver-related mortality. A number of extrahepatic manifestations are also reported in CHC patients, further adding to the burden of the disease. CHC also impacts patients in terms of lower health-related quality of life, higher levels of fatigue and reduced productivity. Furthermore, the later stages of disease are costly for both healthcare systems and society. Pegylated-interferon (PEG-IFN)+ribavirin (RBV), for many years the mainstay of treatment, leads to sustained virological response (SVR) in 40%-70% of patients. However, a substantial number of patients are ineligible for treatment, and many patients fail to achieve SVR with this regimen. Furthermore, PEG-IFN+RBV leads to impairment of patient-reported outcomes during treatment, and most patients suffer from adverse events, associated with poor adherence, treatment discontinuation and treatment failure. The approval of second-generation direct-acting antivirals (DAAs) has revolutionized the treatment of CHC patients. All-oral, PEG-IFN and RBV-free regimens have higher efficacy rates, shorter treatment durations, fewer adverse events, higher adherence rates and improvement in PROs from as early as Week 4, compared to PEG-IFN+RBV regimens. The aim of this article is to review the evidence for HCV infection as a systemic disease, summarizing the impact of hepatitis C and its treatments on clinical, patient and economic outcomes, with a focus on data from Asia and Japan specifically.


cost-effectiveness; health-related quality of life; hepatitis C; patient-reported outcomes; work productivity

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