title: Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016.
abstract: India contributes significantly to the global burden of HCV. While the nucleoside NS5B inhibitor sofosbuvir became available in the Indian market in March 2015, the other directly acting agents (DAAs), Ledipasvir and Daclatasvir, have only recently become available in the India. The introduction of these DAA in India at a relatively affordable price has led to great optimism about prospects of cure for these patients as not only will they provide higher efficacy, but combination DAAs as all-oral regimen will result in lower side effects than were seen with pegylated interferon alfa and ribavirin therapy. Availability of these newer DAAs has necessitated revision of INASL guidelines for the treatment of HCV published in 2015. 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. The availability of combination DAA therapy has simplified therapy of HCV with decreased reliance of evaluation for monitoring viral kinetics or drug related side effects.
authors: Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India.
authors: Pankaj
authors: P
authors: Puri
authors: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors: Vivek A
authors: VA
authors: Saraswat
authors: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors: Radha K
authors: RK
authors: Dhiman
authors: Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi 110076, India.
authors: Anil C
authors: AC
authors: Anand
authors: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors: Subrat K
authors: SK
authors: Acharya
authors: Department of Gastroenterology, SCB Medical College, Cuttack 753007, India.
authors: Shivaram P
authors: SP
authors: Singh
authors: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors: Yogesh K
authors: YK
authors: Chawla
authors: Department of Gastroenterology, Bombay Hospital, Mumbai 400020, India.
authors: Deepak N
authors: DN
authors: Amarapurkar
authors: Department of Gastroenterology and Hepatology, Fortis Escorts Liver and Digestive Diseases Institute, New Delhi 110076, India.
authors: Ajay
authors: A
authors: Kumar
authors: Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi 110060, India.
authors: Anil
authors: A
authors: Arora
authors: Department of Gastroenterology, Banaras Hindu University, Varanasi 221005, India.
authors: Vinod K
authors: VK
authors: Dixit
authors: Department of Hepatology, Lakeshore Hospital, Cochin 682304, India.
authors: Abraham
authors: A
authors: Koshy
authors: Department of Gastroenterology, Dayanand Medical College, Ludhiana 141001, India.
authors: Ajit
authors: A
authors: Sood
authors: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors: Ajay
authors: A
authors: Duseja
authors: Department of Gastroenterology, Global Hospital, Hyderabad 500004, India.
authors: Dharmesh
authors: D
authors: Kapoor
authors: Department of Gastroenterology, Artemis Hospital, Gurgaon 122001, India.
authors: Kaushal
authors: K
authors: Madan
authors: Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors: Anshu
authors: A
authors: Srivastava
authors: Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi 110060, India.
authors: Ashish
authors: A
authors: Kumar
authors: Department of Gastroenterology and Hepatology, Fortis Escorts Liver and Digestive Diseases Institute, New Delhi 110076, India.
authors: Manav
authors: M
authors: Wadhawan
authors: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors: Amit
authors: A
authors: Goel
authors: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors: Abhai
authors: A
authors: Verma
authors: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors: Shalimar
authors: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors: Gaurav
authors: G
authors: Pandey
authors: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
authors: Rohan
authors: R
authors: Malik
authors: Department of Gastroenterology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, India.
authors: Swastik
authors: S
authors: Agrawal
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; DCV, daclatasvir; EIA, enzyme immunoassay; ESRD, end-stage renal disease; EVR, early virological response; FCH, fibrosing cholestatic hepatitis; GT, genotype; HCV; HCV, hepatitis C virus; HCWs, healthcare workers; HIV, human immunodeficiency virus; INASL, Indian National Association for Study of the Liver; IU, international units; LDV, ledipasvir; LT, liver transplantation; NS, nonstructural protein; NSI, needlestick injury; PCR, polymerase chain reaction; Peg-IFNα, pegylated interferon alfa; RBV, ribavirin; RVR, rapid virological response; SOF, sofosbuvir; SVR, sustained virological response; ULN, upper limit of normal; anti-HCV, antibody to HCV; antiviral therapy; chronic hepatitis; hepatitis C virus