Diagnosis, Management And Prevention Of Hepatitis C In Pakistan 2017.

AIMS AND OBJECTIVES: Since the advent of direct acting antiviral agents, there is a revolutionary change in the management of HCV infection. Newer drugs with different mechanism of action are being introduced and are expected to be available in coming few months in Pakistan as well. The main purpose of the guideline is to review and induct the latest research in field of HCV infection in Pakistani perspective so that our healthcare professionals can apply the new recommendations in timely and judicial manner. Target groups of guidelines are general physicians treating hepatitis C, hepatologists and gastroenterologists. Other beneficiaries of these guidelines are public health institutions of Pakistan, which provide free treatment to deserving patients under National Hepatitis Prevention and Control Program and Pakistan Bait-ul- Mal Program. METHODOLOGY: These guidelines are based on the review of National consensus practice guidelines: Diagnosis, Management and Prevention of Hepatitis C Pakistan 2009. Published data in National and International Journals searched with the help of Google search and pub med, and 2015-16 guidelines of HCV by AASLD, EASL, APASL and WHO. Local studies are preferably added with references to enhance the Pakistani perspective. Evidence was also taken from published studies. Recommendations have been based upon evidence from national publications on the subject and scientific presentations at national liver meeting as well from experts' personal experience and opinion.

Early predictability of virological response in patients of chronic hepatitis-C with genotype-3, treated with pegylated interferon and ribavirin.

BACKGROUND: This study was conducted to assess the early predictability of virological response in chronic hepatitis-C patients (Genotype-3), treated with pegylated interferon alpha-2a and ribavirin with an objective of determining predictive values of Rapid Virological Response (RVR) and Early Virological Response (ETR) on Sustained Virological Response (SVR). METHOD: This cross sectional study was conducted in January 2014, at Holy Family Hospital, Rawalpindi by inclusion of 582 patients of chronic hepatitis being treated with Pegylated Interferon a 2b and ribavirin. Based on Polymerase Chain Reaction (PCR) for HCV RNA Qualitative on 4th, 12h and 24th week of treatment regimen, RVR, EVR and End treatment Response (ETR) was assessed respectively whereas 24th week post treatment PCR concluded as SVR. Effect of treatment was determined as proportions for responses in total and then compared for treatment naive, responders and relapsers to previous conventional therapy using Chi square test. Positive and Negative Predictive Values were also calculated. RESULTS: Qualitative PCR for HCV revealed that 281 (69.2%) achieved RVR where 60.3% attained SVR. PPV and NPV of RVR in study population were 67.41% and 44.45% respectively and 66.29% and 57.14% respectively for EVR..Statistically significant differences in RVR, EVR and ETR were observed in patients based on conventional treatment response. CONCLUSION: Attainment of RVR is a prospect to categorize patients appropriate for abridged treatment and this study supported the evidence that failure to achieve EVR was congruent with failure to achieve SVR.