title: Most Patients of Hepatitis C Virus Infection in India Present Late for Interferon-Based Antiviral Treatment: An Epidemiological Study of 777 Patients from a North Indian Tertiary Care Center.
abstract: BACKGROUND
  Interferon-based antiviral therapy is offered only to those HCV patients who have either chronic hepatitis or early cirrhosis. Advanced cirrhotics do not tolerate interferon-based therapy. Since HCV is asymptomatic in early stages and usually presents late, the eligibility for interferon-based therapy is thus limited. There are scarce studies from India, which looked specifically the eligibility of interferon-based therapy in HCV patients.
  
  
  OBJECTIVE
  To study the spectrum of presentation of HCV infection, determine their eligibility for interferon-based therapy, and follow for SVR.
  
  
  METHODS
  The records of all consecutive patients of HCV, >14 years age, who presented to our department between 2008 and 2014, were analyzed for categorization into chronic hepatitis, cirrhosis and hepatocellular carcinoma. Patients with detectable HCV RNA who have chronic hepatitis or Child A cirrhosis were considered eligible for Peg-interferon and ribavirin. Patients who received treatment were followed for SVR.
  
  
  RESULTS
  777 patients (median age 49 [range 15-95] years, males 69%) were included. Cirrhosis was the most common presentation (56%, 439/777) followed by chronic hepatitis (37%, 287/777) and HCC (7%, 51/777). Of patients who had cirrhosis (including those with HCC), 36% (174/490) were Child A; 51% (250/490) were Child B and 14% (66/490) were Child C. Only 347/777 (45%) were eligible for Peg-interferon-alpha and Ribavirin. Among the remaining 430 patients, in 326 (76%) the disease was far too advanced. Of eligible patients only 54% actually received Peg-interferon-alpha and Ribavirin and 81% patients could complete the course. Of them only 70% could achieve SVR.
  
  
  CONCLUSIONS
  Most HCV patients in India present late and only about 45% are eligible for Interferon-based antiviral treatment. At presentation 56% patients already have cirrhosis and 7% have HCC. Since HCV is usually asymptomatic in early stages, awareness about screening should be increased so that more patients are diagnosed early before they develop cirrhosis or HCC.
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singla
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Arora
keywords: AFP, Alphafetoprotein; ALT, Alanine aminotransferase; ANA, Antinuclear antibody; BCLC, Barcelona Clinic Liver Cancer; DAA, Directly acting agents; FNAC, Fine needle aspiration cytology; HBV, Hepatitis B virus; HCC, Hepatocellular carcinoma; HCV, Hepatitis C virus; HIV, Human immunodeficiency virus; PCR, Polymerase chain reaction; PEG-IFN, Pegylated Interferon; RBV, Ribavirin; RNA, Ribonucleic acid; SMA, Smooth Muscle Antibody; SVR, Sustained virological response; WHO, World health organization; chronic liver disease; cirrhosis; epidemiology; hepatitis C; hepatocellular carcinoma