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.