title: Consensus Statement of HCV Task Force of the Indian National Association for Study of the Liver (INASL). Part II: INASL Recommendations for Management of HCV in India.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Army Hospital (R & R), New Delhi 110010, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Puri
authors.affiliation: Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi 110076, India.
authors.forename: Anil C
authors.initials: AC
authors.lastname: Anand
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical, Sciences, Lucknow, Uttar Pradesh 221016, India.
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Saraswat
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Subrat K
authors.initials: SK
authors.lastname: Acharya
authors.affiliation: Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Sarin
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and, Research, Chandigarh 160012, India.
authors.forename: Radha K
authors.initials: RK
authors.lastname: Dhiman
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical, Sciences, Lucknow, Uttar Pradesh 221016, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
authors.affiliation: Department of Gastroenterology, SCB Medical College, Cuttack, Odisha 753007, India.
authors.forename: Shivaram P
authors.initials: SP
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, Bombay Hospital, Mumbai, Maharashtra 400020, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Amarapurkar
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi 110060, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Arora
authors.affiliation: Department of Gastroenterology, Fortis Hospital, Mohali, Punjab 160047, India.
authors.forename: Mohinish
authors.initials: M
authors.lastname: Chhabra
authors.affiliation: Department of Gastroenterology, International Hospital, Guwahati, Assam 781005, India.
authors.forename: Kamal
authors.initials: K
authors.lastname: Chetri
authors.affiliation: Department of Gastroenterology, Fortis Hospital, Gurgaon, Haryana 122002, India.
authors.forename: Gourdas
authors.initials: G
authors.lastname: Choudhuri
authors.affiliation: Department of Gastroenterology, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Dixit
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and, Research, Chandigarh 160012, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Duseja
authors.affiliation: Department of Gastroenterology, Choithram Hospital & Research Centre, Indore, Madhya Pradesh 452014, India.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Jain
authors.affiliation: Department of Gastroenterology, Global Hospital, Hyderabad, Andhra Pradesh 500004, India.
authors.forename: Dharmesh
authors.initials: D
authors.lastname: Kapoor
authors.affiliation: Department of Gastroenterology, LNJP Hospital, and Maulana Azad Medical College, New Delhi 110002, India.
authors.forename: Premashis
authors.initials: P
authors.lastname: Kar
authors.affiliation: Department of Hepatology, Lakeshore Hospital, Cochin, Kerala 682304, India.
authors.forename: Abraham
authors.initials: A
authors.lastname: Koshy
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi 110060, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Gastroenterology, Medanta Medicity, Gurgaon, Haryana 122001, India.
authors.forename: Kaushal
authors.initials: K
authors.lastname: Madan
authors.affiliation: Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh 211001 India.
authors.forename: Sri P
authors.initials: SP
authors.lastname: Misra
authors.affiliation: Department of Gastroenterology, VGM Hospital, Coimbatore, Tamil Nadu 641005, India.
authors.forename: Mohan V G
authors.initials: MV
authors.lastname: Prasad
authors.affiliation: Department of Gastroenterology, Jaslok Hospital, Mumbai, Maharashtra 400026, India.
authors.forename: Aabha
authors.initials: A
authors.lastname: Nagral
authors.affiliation: Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
authors.forename: Amarendra S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu 632004, India.
authors.forename: R
authors.initials: R
authors.lastname: Jeyamani
authors.affiliation: Department of Gastroenterology, Medanta Medicity, Gurgaon, Haryana 122001, India.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Saigal
authors.affiliation: Department of Gastroenterology, Global Hospital, Mumbai, Maharashtra 400078, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Medicine, Armed Forces Medical College, Pune, Maharashtra 411040, India.
authors.forename: Praveen K
authors.initials: PK
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab 141001, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Sood
authors.affiliation: Department of Gastroenterology, Army Hospital (R & R), New Delhi 110010, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Thareja
authors.affiliation: Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi 110076, India.
authors.forename: Manav
authors.initials: M
authors.lastname: Wadhawan
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