title: Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection in 2015.
abstract: Overall prevalence of HCV infection in India has been estimated to be approximately 1.3% in the general population. Recent introduction of sofosbuvir in India at a relatively affordable price has led to great optimism about prospects of cure for these patients. This drug is likely to form the backbone of current and future treatment regimes for HCV infection, displacing pegylated interferon. Availability of directly acting antiviral drugs (DAAs) has necessitated revision of INASL guidelines for the treatment of HCV published in 2014, as has happened across the world. Current considerations for the treatment of HCV in India include the poorer response of genotype 3, nonavailability of many of the DAAs recommended by other guidelines and the cost of therapy. Since only one DAA, sofosbuvir, is available in India, only two sofosbuvir-based regimes are possible: either dual drug therapy in combination with ribavirin alone for 6 months or triple drug therapy in combination with ribavirin and pegylated interferon for 3 months. The utility of these regimes in various situations has been discussed. Availability of a few other newer DAAs, expected in 2016, is expected to lead to more widespread use of these agents. Current guidance will be updated once newer DAAs, newer evidence with DAAs and 'real-life experience' with use of DAAs accumulate in India.
authors.affiliation: Department of Internal Medicine, Armed Forces Medical College, Pune 411040, 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 226014, 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: 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: Institute of Liver and Biliary Sciences, VasantKunj, New Delhi 110070, India.
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Sarin
authors.affiliation: Department of Gastroenterology, SCB Medical College, Cuttack 753007, India.
authors.forename: Shivaram P
authors.initials: SP
authors.lastname: Singh
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Chawla
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
authors.affiliation: Department of Gastroenterology, Bombay Hospital, Mumbai 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, Banaras Hindu University, Varanasi 221005, India.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Dixit
authors.affiliation: Department of Gastroenterology, Dayanand Medical College, Ludhiana 141001, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Sood
authors.affiliation: Department of Gastroenterology, Global Hospital, Mumbai 400078, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Shah
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, Global Hospital, Hyderabad 500004, India.
authors.forename: Dharmesh
authors.initials: D
authors.lastname: Kapoor
authors.affiliation: Department of Gastroenterology, Artemis Hospital, Gurgaon 122001, India.
authors.lastname: Shalimar
authors.affiliation: Department of Gastroenterology, Artemis Hospital, Gurgaon 122001, India.
authors.forename: Kaushal
authors.initials: K
authors.lastname: Madan
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Pande
authors.affiliation: Department of Gastroenterology, Jaslok Hospital, Mumbai 400026, India.
authors.forename: Aabha
authors.initials: A
authors.lastname: Nagral
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 682304, India.
authors.forename: Abraham
authors.initials: A
authors.lastname: Koshy
authors.affiliation: Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
authors.forename: Amarender S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Gastroenterology, Christian Medical College, Vellore 632004, India.
authors.forename: C E
authors.initials: CE
authors.lastname: Eapen
authors.affiliation: Department of Gastroenterology, Army Hospital (R & R), New Delhi 110010, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Thareja
keywords: ALT, alanine aminotransferase; ANC, absolute neutrophil count; AST, aspartate aminotransferase; CH-C, chronic hepatitis C; CTP, Child-Turcotte Pugh; DAA, directly acting antiviral agents; EIA, enzyme immunoassay; ESRD, end stage renal disease; EVR, early virological response; HCV; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IFN-α, interferon alfa; INASL, Indian National Association for Study of the Liver; PCR, polymerase chain reaction; Peg-IFNα, pegylated interferon alfa; RBV, ribavirin; RVR, rapid virological response; SOC, standard of care; SVR, sustained virological response; Sof, sofosbuvir; ULN, upper limit of normal; anti-HCV, antibody to HCV; antiviral therapy; chronic hepatitis; hepatitis C virus