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Table of Contents   
EDITORIAL COMMENTARY  
Year : 2017  |  Volume : 10  |  Issue : 2  |  Page : 311-312
Advocating for the implementation of the updated guidelines for the management of Hepatitis C infection universally


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

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Date of Web Publication22-Jun-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Advocating for the implementation of the updated guidelines for the management of Hepatitis C infection universally. Ann Trop Med Public Health 2017;10:311-2

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Advocating for the implementation of the updated guidelines for the management of Hepatitis C infection universally. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Nov 20];10:311-2. Available from: http://www.atmph.org/text.asp?2017/10/2/311/208709
Hepatitis C is a liver disease due to infection with hepatitis C virus (HCV) that can result in both acute and chronic forms of disease.[1] The current global estimates reflect that close to 150 million people have the chronic infection worldwide, of which a significant proportion of them eventually present with complications of liver cirrhosis or malignancy or failure.[1] Despite the disease being universal in distribution, it is most common in African and Central-East Asian region.[1],[2]

Further, every year almost 0.7 million people lose their lives due to the complications of the disease and it is a serious concern as around 90% of the infected persons can be completely cured through the use of appropriate antiviral medications.[1] Now the question arises, if that is the case, why the health sector has been so ineffective in improving the prognosis of the disease?[1],[3] This can be attributed by two major reasons, namely owing to the asymptomatic nature of the disease, the majority of the infected individuals are not aware of the disease, and thus, often presents late to the health sector; and even those who are diagnosed with the infection, their outcome is not encouraging primarily because of the poor treatment access in heterogeneous settings.[1],[2],[3]

In order to support the policy makers and the health professionals, the World Health Organization has released an updated guideline to enable treatment of infected persons with direct-acting antivirals (DAA), in an evidence-based manner.[4] These DAA medicines have modified the treatment regimen not only in terms of short duration of therapy (8 weeks), but even with regard to their oral administration, lesser incidence of adverse effects, and improved cure rates, in contrast to the earlier regimens.[4],[5] Specific regimens have been proposed based on the genotype of the virus isolated, clinical history of the patient, treatment during pregnancy/coinfected patients, and due care has been taken to consider drug interactions.[4],[5] In-fact, different treatment options have been suggested based on the cost for treating single individual and for a specific group of the population.[5]

The proposed recommendations can be implemented universally, but essentially targets the programme managers from low-income and middle-income nations to empower them to develop nation-specific treatment regimen (based on cost and availability of drugs) and even assist them in the microplanning activities (like responsibility of health workers, monitoring treatment response, or adverse effects).[4],[5],[6] The main recommendation is to use only DAA regimens for the treatment of persons with HCV infection, except for HCV genotype 3 infection with cirrhosis or HCV genotypes 5 and 6 infections with and without cirrhosis (use interferon-based regimen as an alternative treatment option).[4]

In addition, the existing recommendations pertaining to screening of individuals from high-risk population groups or individuals with a history of high-risk behavior, confirmation of diagnosis based on the serological test and viral ribonucleic acid isolation, assessment of the extent of liver fibrosis/cirrhosis, and use of pegylated interferon and ribavirin for treatment of chronic infection, have been reiterated.[4],[6] Even though, precise recommendations have been released, its immediate implementation is difficult owing to the high cost of drugs, pending approval for drugs in many nations, and poor awareness among clinicians about the recommended drugs or its availability.[2],[4] However, the main objective is to sensitize policy makers regarding the existence of the guidelines, time for initiation of therapy, and to establish the guidelines for laboratory testing, or follow-up of patients after beginning treatment.[4] In addition, there is an extensive need to focus our attention towards increasing awareness activities, mobilize resources, develop partnerships with stakeholders, implement measures to prevent transmission of the disease, and accelerate the efforts for the development of the vaccine, to improve the overall scenario.[1],[2]

To conclude, the incidence of Hepatitis-C infection and the associated complications is on the rise globally. Thus, it is the responsibility of each of the stakeholders to ensure that specific guidelines should be adhered for the diagnosis and management of the infection, in order to reduce the burden of the disease and minimize the risk of the development of complications

Acknowledgement

S.R.S. contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

P.S.S. contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

J.R. contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

 
   References Top

1.
World Health Organization. Hepatitis Fact sheet N°164; 2015. Accessed Available from: http://www.who.int/mediacentre/factsheets/fs164_apr2014/en/. [Last accessed on 17 April 2016].  Back to cited text no. 1
    
2.
Álvaro-Meca A, Jiménez-Sousa MA, Boyer A, Medrano J, Reulen H, Kneib T. Impact of chronic hepatitis C on mortality in cirrhotic patients admitted to intensive-care unit. BMC Infect Dis 2016;16:122.  Back to cited text no. 2
    
3.
Janahi EM, Al-Mannai M, Singh H, Jahromi MM. Distribution of hepatitis C virus genotypes in Bahrain. Hepat Mon 2015;15:e30300.  Back to cited text no. 3
    
4.
World Health Organization. Guidelines for the screening care treatment of persons with chronic hepatitis C infection - Updated version April 2016; Geneva WHO press 1-26.  Back to cited text no. 4
    
5.
Tamori A, Enomoto M, Kawada N. Recent advances in antiviral therapy for chronic hepatitis C. Mediators Inflamm 2016;2016:6841628.  Back to cited text no. 5
    
6.
Thompson AJ. Australian recommendations for the management of hepatitis C virus infection: a consensus statement. Med J Aust 2016;204:268-72.  Back to cited text no. 6
    

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Correspondence Address:
Saurabh R Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd floor, Ammapettai village, Thiruporur: Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.208709

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