title: Management of hepatitis C virus infection in the Asia-Pacific region: an update.
abstract: The Asia-Pacific region has disparate hepatitis C virus (HCV) epidemiology, with prevalence ranging from 0·1% to 4·7%, and a unique genotype distribution. Genotype 1b dominates in east Asia, whereas in south Asia and southeast Asia genotype 3 dominates, and in Indochina (Vietnam, Cambodia, and Laos), genotype 6 is most common. Often, availability of all-oral direct-acting antivirals (DAAs) is delayed because of differing regulatory requirements. Ideally, for genotype 1 infections, sofosbuvir plus ledipasvir, sofosbuvir plus daclatasvir, or ombitasvir, paritaprevir, and ritonavir plus dasabuvir are suitable. Asunaprevir plus daclatasvir is appropriate for compensated genotype 1b HCV if baseline NS5A mutations are absent. For genotype 3 infections, sofosbuvir plus daclatasvir for 24 weeks or sofosbuvir, daclatasvir, and ribavirin for 12 weeks are the optimal oral therapies, particularly for patients with cirrhosis and those who are treatment experienced, whereas sofosbuvir, pegylated interferon, and ribavirin for 12 weeks is an alternative regimen. For genotype 6, sofosbuvir plus pegylated interferon and ribavirin, sofosbuvir plus ledipasvir, or sofosbuvir plus ribavirin for 12 weeks are all suitable. Pegylated interferon plus ribavirin has been replaced by sofosbuvir plus pegylated interferon and ribavirin, and all-oral therapies where available, but cost and affordability remain a major issue because of the absence of universal health coverage. Few patients have been treated because of multiple barriers to accessing care. HCV in the Asia-Pacific region is challenging because of the disparate epidemiology, poor access to all-oral therapy because of availability, cost, or regulatory licensing. Until these problems are addressed, the burden of disease is likely to remain high.
authors.affiliation: Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore. Electronic address: mdclimsg@nus.edu.sg.
authors.forename: Seng Gee
authors.initials: SG
authors.lastname: Lim
authors.affiliation: UOC Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Aghemo
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University School of Medicine, Taipei, Taiwan.
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
authors.forename: Yock Young
authors.initials: YY
authors.lastname: Dan
authors.affiliation: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Edward
authors.initials: E
authors.lastname: Gane
authors.affiliation: Hepatology Division, Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia.
authors.forename: Rino
authors.initials: R
authors.lastname: Gani
authors.affiliation: Stanford University Hospitals and Clinics, Palo Alto, CA, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gish
authors.affiliation: Department of Gastroenterology, Mount Elizabeth Medical Centre, Singapore, Singapore.
authors.forename: Richard
authors.initials: R
authors.lastname: Guan
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Xicheng, Beijing, China.
authors.forename: Ji Dong
authors.initials: JD
authors.lastname: Jia
authors.affiliation: Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
authors.forename: Kieron
authors.initials: K
authors.lastname: Lim
authors.affiliation: NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Teerha
authors.initials: T
authors.lastname: Piratvisuth
authors.affiliation: Department of Hepatology, Institute of Liver Disease, HPB Surgery and Transplant, Global Hospital, Parel, Mumbai, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Shah
authors.affiliation: Liver Institute of Virginia, Bon Secours Health System, Richmond, VA, USA.
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.affiliation: Department of Medicine III, University Hospital Aachen, Aachen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Tacke
authors.affiliation: Department of Hepatology, Selayang Hospital, Selangor, Malaysia.
authors.forename: Soek Siam
authors.initials: SS
authors.lastname: Tan
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok-noi, Bangkok, Thailand.
authors.forename: Tawesak
authors.initials: T
authors.lastname: Tanwandee
authors.affiliation: Yangon GI and Liver Centre, Pabedan, Yangon, Myanmar.
authors.forename: Khin Maung
authors.initials: KM
authors.lastname: Win
authors.affiliation: Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey.
authors.forename: Cihan
authors.initials: C
authors.lastname: Yurdaydin
mesh_terms: D000998:Antiviral Agents / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D060085:Coinfection; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D010139:Pacific Islands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents