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HCV Treatment with Sofosbuvir in Pakistan; Current Scenario and Future Perspective

Ayesha Khaliq, Imtiaz Ahmad, Muhammad Sohail Afzal

Ayesha Khaliq, Imtiaz Ahmad, Muhammad Sohail Afzal, School of Science, University of Management and Technology (UMT), Lahore, Pakistan

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http: //creativecommons.org/licenses/by-nc/4.0/

Correspondence to: Muhammad Sohail Afzal, School of Science, University of Management and Technology (UMT), Lahore, Pakistan. Email: sohail.ncvi@gmail.com Telephone: +92-321-5244808 Received: March 3, 2018 Revised: March 18, 2018 Accepted: March 21, 2018 Published online: April 21, 2018

ABSTRACT

Hepatitis C Virus (HCV) is a global problem with around 1.75 million new infections yearly. With approximate 70% chronicity rate about 399,000 people die each year from hepatitis C. Pakistan is endemic for this infection with 5-8% prevalence in general population. There are several HCV genotypes and antiviral therapies are genotype dependent. In Pakistan genotype 3a is dominant followed by diagnostically untypable HCV variants. Previously interferon based antiviral regimens were the only choice for HCV treatment in Pakistan. Recently sofosbuvir is introduced in Pakistan on heavily discount. Although sofosbuvir showed very good sustained virological response (SVR) globally but due to different ethnicity and genetic makeup, it is important to analyse the drug efficacy in Pakistan. Available limited data showed that overall SVR/rapid virological response (RVR) is very good. The current data is very limited and it is highly needed to have studies reporting the sofosbuvir treatment response from different ethnic groups from the whole country.

Key words: HCV; Treatment; Sofosbuvir; Direct acting antivirals; Pakistan

© 2018 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Khaliq A, Ahmad I, Afzal MS. HCV Treatment with Sofosbuvir in Pakistan; Current Scenario and Future Perspective. Journal of Gastroenterology and Hepatology Research 2018; 7(2): 2578-2580 Available from: URL: http: //www.ghrnet.org/index.php/joghr/article/view/2294

LETTER TO THE EDITOR

Hepatitis C Vitus (HCV) is the global problem with more than 170 million infections[1]. It has been estimated from modelling that in 2015, there were 1.75 million new HCV infections develop worldwide (globally, 23.7 new HCV infections per 100,000 people)[2]. Approximately 60-80% of infected individual are converted into chronic infections while around 15-30% are ultimately develop hepatocellular carcinoma (HCC). About 399,000 people die each year from hepatitis C, mostly from cirrhosis and HCC[2]. Pakistan is a country with a very high burden of HCV. It is estimated that around 5-8% general population is infected with this silent killer[3-4]. It is recently highlighted that around 10-11 million individual of Pakistan are infected with HCV[3-5]. Prevalence of HCV in high risk groups like injection drug users (IDUs), multi-transfused individuals, individual undergone medical/dental procedures, people treated by ill equipped health care system is very high (30-70%) . Low education of health care provides and general population about the prevalence routs of HCV makes condition more alarming and leads to increasing burden of HCV every year[3-6].

There are six major HCV genotypes and several sub-types due to error prone nature of viral polymerase. Geographical distribution of HCV genotypes is different globally. Disease pathogenesis of different viral genotypes is significantly varies. Different genotypes showed variable physiological effects in infected individuals and can leads to differential extra-hepatic manifestations as well[7]. The course of antiviral treatment is also viral genotype dependent[8]. Viral genotypes and sub-types respond in a different way, hence it is very important for health care providers to know the causative viral genotype before starting the antiviral therapy. There are several studies investigating the prevalence of HCV genotypes from different areas of Pakistan. Recently, we have reviewed the available data from Pakistan regarding the prevalence of HCV genotypes and the data showed that 3a genotype is the most prevalent (63%) followed by genotypes 1 (09%) and 2 (08%) along with an alarming number of diagnostically untypable viral genotypes (14%) in the local community[8-9].

Previously HCV was treated with interferon based antiviral regimens. The treatment response of interferon based antiviral therapy is fairly genotype dependent[10]. Although sustained virological response (SVR) was quite good against most prevalent HCV genotype (3a) in Pakistan, it is difficult to bear for most of the patients due to severe side effects. There are several studies analysing the efficiency of interferon based therapy against 3a GT in Pakistan. The results showed that 60-90% individual showed SVR when treated with interferon based antiviral therapy[11].

Recently with the advancement of research in the field of Direct Acting Antivirals (DAAs), FDA approved several DAAs for HCV treatment. Due to high cost, initially it was very difficult to get treatment with DAAs in most of the developing countries including Pakistan. However recently sofosbuvir (NS5B inhibitor) was introduce in Pakistan on heavily discounted price. Sofosbuvir showed good SVR in European and Caucasian populations. Pakistan is a country with different genetic makeup as compared to European and Caucasian. The viral genotype prevalence pattern is also different in Pakistan with 3a is most prevalent one. So it is very important to have an actual idea about the SVR in individuals infected with 3a genotype in Pakistan. The results of actual population based studies are important to know about the efficiency of therapy and to design the therapy dose/duration for local community. Keeping in mind this important aspect of therapy success and future prediction, the current study was designed to analyse the available data regarding the HCV treatment with sofosbuvir from Pakistan. Literature survey showed that there are only 07 studies reporting the antiviral response of sofosbuvir in Pakistan[12-18]. The available limited data showed that overall sustained virological response (SVR)/rapid virological response (RVR) is very good. The literature search resulted into retrieval of only seven studies regarding the HCV treatment with sofosbuvir based antiviral regimen. A first report was in 2016 from Rawalpindi city which included 502 patients treated with sofosbuvir and among those 91% showed RVR[12]. Capileno et al. (2017) study from Karachi included 153 patients and reported that 84% patients showed RVR[13]. The detailed analysis of available data suggested a very good response for this DAA antiviral regimen in different cities with overall 80-100% SVR/RVR[13-18]. There is also a study which included 37 renal transplant HCV patients from Karachi and sofosbuvir treatment showed 89.2% RVR for these individuals[19].  

The available data is very limited so it is difficult to predict or apply the therapy response for the whole country. The available reports are only from four major cities i.e. Karachi, Lahore, Rawalpindi and Faisalabad and no study is available from other parts of the country. In Pakistan there are several ethnic groups residing in different geographical areas. Different provinces consists of entirely different ethnic races and there are several sub ethnic communities in different regions of Pakistan. The difference in genetic background may effect the antiviral therapy response so it is highly needed to have studies reporting the sofosbuvir treatment response from the whole country. As Government of Pakistan recently took an initiative to give free treatment to hepatitis C patients. The data of these treated patients from all across the country should be documented and be used for future guidelines formulations for treatment of different viral genotypes. The response may vary according to the host genotype and future treatment guidelines should be designed accordingly. In this way maximum benefit can be attain with this advancement of antiviral treatment.

REFERENCES

1. Ravi S, Nasiri-Toosi M, Karimzadeh I, Khalili H, Ahadi-Barzoki M, Dashti-Khavidaki S. Pattern and associated factors of anti-hepatitis C virus treatment induced adverse reactions. Expert Opin Drug Saf 2014; 13: 277-286. [DOI: 10.1517/14740338.2014.866091]; [PMID: 24386997]

2. WHO. 2017. Available from http: //www.who.int/mediacentre/factsheets/fs164/en/ (accessed on 5th Feb 2018)

3. Afzal MS. Are efforts up to the mark? A cirrhotic state and knowledge about HCV prevalence in general population of Pakistan. Asian Pac J Trop Med. 2016; 9: 616-8. [DOI: 10.1016/j.apjtm.2016.04.013]; [PMID: 27262079]

4. Arshad A, Ashfaq UA. Epidemiology of Hepatitis C Infection in Pakistan: Current Estimate and Major Risk Factors. Crit Rev Eukaryot Gene Expr. 2017; 27: 63-77. [DOI: 10.1615/CritRevEukaryotGeneExpr.2017018953]; [PMID: 28436333]

5. Umer M and Iqbal M. Hepatitis C virus prevalence and genotype distribution in Pakistan: Comprehensive review of recent data. World J Gastroenterol. 2016; 22: 1684-1700. [DOI: 10.3748/wjg.v22.i4.1684]; [PMID: 26819533]

6. Afzal MS, Iqbal MA. Hepatitis C Virus in Pakistan: Community Education Is an Effective Weapon Against the Killer. Viral Immunol. 2017; 30: 548-551. [DOI: 10.1089/vim.2016.0171]; [PMID: 28622101]

7. Messina JP, Humphreys I, Flaxman A, Brown A, Cooke GS, Pybus OG, Barnes E. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology 2015; 61: 77-87. [DOI: 10.1002/hep.27259]; [PMID: 25069599]

8. Afzal MS. Hepatitis C Virus and Interferon-Free Antiviral Therapeutics Revolution: Implications for Pakistan. Viral Immunol. 2017; 30: 252-257. [DOI: 10.1089/vim.2016.0164]; [PMID: 28118096]

9. Afzal MS, Shah ZH, Ahmed H. Recent HCV genotype changing pattern in the Khyber Pakhtunkhwa province of Pakistan; is it pointing out a forthcoming problem? Braz J Infect Dis. 2016; 20: 312-3. [DOI: 10.1016/j.bjid.2015.12.011]; [PMID: 26963150]

10. Kanda T, Imazeki F, Yokosuka O. New antiviral therapies for chronic hepatitis C. Hepatol Int. 2010; 4: 548-561. [DOI: 10.1007/s12072-010-9193-3]; . [PMID: 21063477]

11. Afzal MS. Predictive potential of IL-28B genetic testing for interferon based hepatitis C virus therapy in Pakistan: Current scenario and future perspective. World J Hepatol. 2016; 8: 1116-1118. [DOI: 10.4254/wjh.v8.i26.1116]; [PMID: 27660680]

12. Akhter TS, Umar M, Khaar HT, Aslam F, Nisar G, Naseer A, Ahmad S, Osama M. Sofosbuvir for the treatment of hepatitis c genotype 3 infected patients in Pakistan. J Ayub Med Coll Abbottabad 2016; 28: S884-S889. [PMID: 28782338]

13. Capileno YA, Van den Bergh R, Donchuk D, Hinderaker SG, Hamid S, Auat R, Khalid GG, Fatima R, Yaqoob A, Van Overloop C. Management of chronic Hepatitis C at a primary health clinic in the high-burden context of Karachi, Pakistan. PLoS One 2017; 12: e0180286. [DOI: 10.1371/journal.pone.0180286]; [PMID: 28640872]

14. Siddique MS, Shoaib S, Saad A, Iqbal HJ, Durrani N. Rapid virological & End treatment response of patients treated with Sofosbuvir in Chronic Hepatitis C. Pak J Med Sci. 2017; 33: 813-817. [DOI: 10.12669/pjms.334.12785]; [PMID: 29067045]

15. Azam Z, Shoaib M, Javed M, Sarwarm MA, Shaikh H, Khokhar N. Initial results of efficacy and safety of Sofosbuvir among Pakistani Population: A real life trial - Hepatitis Eradication Accuracy Trial of Sofosbuvir (HEATS). Pak J Med Sci. 2017; 33: 48-52. [DOI: 10.12669/pjms.331.12352]; [PMID: 28367171]

16. Sarwar S, Khan AA. Sofosbuvir based therapy in Hepatitis C patients with and without cirrhosis: Is there difference? Pak J Med Sci. 2017; 33: 37-41. [DOI: 10.12669/pjms.331.12163]; [PMID: 28367169]

17. Munir B, Ahmed B, Kiran S, Jalal F, Zahoor MK, Shehzadi S, Oranab S, Kamran SK, Ghaffar A. Sorafenib tosylate, Ribavirn and Sofosbuvir combination therapy for HCV virus infected patients with decompensated liver cancer. Pak J Pharm Sci. 2017; 30: 2383-2387. [PMID: 29188773]

18. Iqbal S, Yousuf MH, Yousaf MI. Dramatic response of hepatitis C patients chronically infected with hepatitis C virus genotype 3 to sofosbuvirbased therapies in Punjab, Pakistan: A prospective study. World J Gastroenterol. 2017; 23: 7899-7905. [DOI: 10.3748/wjg.v23.i44.7899]; [PMID: 29209131]

19. Hanif FM, Laeeq SM, Mandhwani RK, Luck NH, Aziz T, Mehdi SH. Effectiveness of Sofosbuvir and Ribavirin for Eradicating Hepatitis C Virus in Renal Transplant Recipients in Pakistan: Where Resources Are Scarce. Exp Clin Transplant 2017; 15: 63-67. [DOI: 10.6002/ect.mesot2016.O50]; [PMID: 28260436]

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