Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV). Not only does Pakistan has some of the highest infection rates, but it also has one of the least responsive hepatitis C viral strains. This combination of factors has spurred the government into establishing a comprehensive programme to eliminate the disease.
HCV belongs to the Flaviviridae family. Chronic hepatitis C is characterised by chronic inflammation that can lead to liver fibrosis, cirrhosis, HCC and death.
Transmission risk factors differ between countries, but primarily occurs through exposure to blood, via medical procedures, poor sterilisation of medical equipment, sharing contaminated devices for injections, mother-to-child transmission, or, rarely, sexual transmission.
The availability of effective, affordable direct-acting antiviral (DAAs) drugs that cure HCV infection has led the World Health Organisation to propose the elimination of HCV by 2030, thereby reducing the burden of HCV induced liver disease and cancer.
To eliminate HCV, the rate of treatment induced viral clearance must exceed that of new infections. Therefore, many countries have embarked upon ‘test and treat’ programs using community testing programs linked to early treatment with highly effective oral anti-viral drugs .
Pakistan’s government is initiating a national program to eliminate HCV infections, but owing to the low responsive nature of the Genotype 3 viral strain with readily available affordable treatments, it will be important to understand how to respond to those that fail first-line treatment and to set guidelines linked to a re-treatment regime, which we are also studying as part of this project.
1. Infections can be either acute or chronic; with 50-80% patients developing chronic hepatitis C.
2. Western countries only account for a small percentage of global HCV infections, with China, Pakistan, India, Egypt and Russia accounting for the majority of viraemic infections.
3. Pakistan has the second largest number of HCV infections globally, with 1 in every 20 Pakistanis being infected.
4. Pakistan has one of the least responsive hepatitis C viral strains (Genotype 3) which is oncogenic with HCC rates approximately five to 15 per cent annually in infected patients with cirrhosis.