Treating Hepatitis C in Asia
February 2010—An estimated 180 million people worldwide have chronic hepatitis C virus infection. Over time, up to 15 percent of them develop progressive liver disease, with rare cases of liver cancer. However, those co-infected with HIV have higher rates of disease progression and end-stage liver disease, or cirrhosis. In addition, co-infected patients may experience greater HIV drug toxicity and poorer responses to antiretroviral and anti-hepatitis treatments.
Treating hepatitis C can reverse cirrhosis and cure the infection. The standard medicine regimen includes pegylated interferon (given by injection under the skin once a week) and ribavirin (capsules or tablets, twice a day). This combination is taken for 24 to 48 weeks, depending on the type of hepatitis C virus in the patient's body and on whether he or she also has HIV. Treatment leads to suppression of the virus, which can be measured by a viral load test. Patients with undetectable hepatitis C viral loads six months after finishing their medicines are said to have a "sustained virologic response" and are considered to have been successfully treated.
There are six different major genotypes of hepatitis C virus; the most common in Asia is genotype 1, which requires a full 48 weeks of treatment.1 In studies of HIV-negative patients with genotype 1 in China, Japan, Korea, and Taiwan, between 44 and 79 percent responded successfully to combination therapy—often higher than rates seen in non-Asian patients in Western countries. Greater expansion of hepatitis C treatment research in South and Southeast Asia would be needed to assess treatment outcomes in resource limited settings and among HIV-positive patients.
1 Yu ML, Chuang WL. Treatment of chronic hepatitis C in Asia: When East Meets West. Journal of Gastroenterology and Hepatology. March 2009;24(3):336–345.