The latest data from the 2015 update of the Hepatitis C Guidelines (hereinafter referred to as the Hepatitis C Guidelines) show that there are approximately 10 million cases of HCV infection in the general population and high-risk groups in China. Currently, the treatment of hepatitis C is progressing well internationally, and most patients have been able to achieve clinical cure; however, three major challenges remain in China.
First, the screening and treatment rates for hepatitis C are low.
In terms of hepatitis C treatment, the current treatment effect is very good and the cure rate can be as high as 90%, but the number of people receiving treatment is relatively small. According to the National Health Planning Commission, the number of reported cases of infectious diseases in 2013 was 203,155, with a projected diagnosis rate of 2%; that is, only 2% of hepatitis C patients in China are currently receiving treatment, which can be considered the “tip of the iceberg”.
Second, the treatment of hepatitis C is not standardized.
In some areas, there are problems of irregular medication, such as insufficient medication regimen, untimely treatment of side effects, and failure to guide treatment according to response, resulting in poor treatment or relapse after discontinuation of medication. Therefore, strengthening the standardization of hepatitis C treatment is the second major challenge that we are currently facing. In addition, some small-molecule drugs against hepatitis C, namely direct antiviral agents (DAAs), have been marketed internationally with good therapeutic effects, but no similar drugs have been approved for clinical use in China. In this situation, how to regulate the purchase and treatment of DAAs is an urgent issue. For this reason, the new version of the Hepatitis C guideline specifically introduces DAAs and gives recommendations on their treatment principles and protocols.
The latest data from the 2015 update of the Hepatitis C Guidelines (hereinafter referred to as the Hepatitis C Guidelines) show that there are approximately 10 million cases of HCV infection in the general population and high-risk groups in China. Currently, the treatment of hepatitis C is progressing well internationally, and most patients have been able to achieve clinical cure; however, three major challenges remain in China.
First, the screening and treatment rates for hepatitis C are low.
In terms of hepatitis C treatment, the current treatment effect is very good and the cure rate can be as high as 90%, but the number of people receiving treatment is relatively small. According to the National Health Planning Commission, the number of reported cases of infectious diseases in 2013 was 203,155, with a projected diagnosis rate of 2%; that is, only 2% of hepatitis C patients in China are currently receiving treatment, which can be considered the “tip of the iceberg”.
Second, the treatment of hepatitis C is not standardized.
In some areas, there are problems of irregular medication, such as insufficient medication regimen, untimely treatment of side effects, and failure to guide treatment according to response, resulting in poor treatment or relapse after discontinuation of medication. Therefore, strengthening the standardization of hepatitis C treatment is the second major challenge that we are currently facing. In addition, some small-molecule drugs against hepatitis C, namely direct antiviral agents (DAAs), have been marketed internationally with good therapeutic effects, but no similar drugs have been approved for clinical use in China. In this situation, how to regulate the purchase and treatment of DAAs is an urgent issue. For this reason, the new version of the hepatitis C guidelines specifically introduces DAAs and gives recommendations on their treatment principles and protocols.
Third, the accessibility and affordability of antiviral drugs are not high.
In many regions of China, interferon and ribavirin are not covered by health insurance or are reimbursed at very low rates, resulting in many patients not actively receiving anti-hepatitis C virus (HCV) therapy after diagnosis. In addition, some of the more effective drugs, such as DAAs, are not yet available in China, and these drugs are very expensive abroad and cheaper in some neighboring regions, but it is uncertain what the future prices will be when they are available in China. Therefore, improving the accessibility and affordability of antiviral drugs is the third major challenge that China is facing.
Professor Tang Hong of West China University of Medical Sciences noted.
”We still need to do a lot of work in the future in order to achieve early diagnosis of the disease, early standardized treatment, affordable treatment, improve the cure rate of hepatitis C patients, and benefit more patients.”
DAAs are purchased abroad, require standardized treatment and follow-up, and should not be self-administered
From international studies and clinical reports, there is no doubt that DAAs are effective, especially interferon-free regimens, which not only have a shorter course but also have fewer side effects; DAAs are also suitable for some special populations, such as patients with cirrhosis, patients with contraindications to interferon therapy, liver transplant patients, and kidney transplant patients, so that more patients can benefit from them. Several international guidelines, including the WHO guidelines and those of the United States and Europe, recommend DAAs for patients with hepatitis C.
Although DAAs are not yet available in China, clinical studies of these drugs are underway in China, and they will soon be available in China. For patients who purchase DAAs from countries or regions outside of mainland China, the biggest issue is the need for standardized medication rather than patient self-administration, such as sofosbuvir, which alone can easily develop resistance and negatively impact subsequent treatment.
Doctors should advise patients who are ready to purchase DAAs that although there are internationally recommended treatment regimens for DAAs, they should seek standardized treatment and standardized follow-up with a specialist. During the treatment process, different treatment regimens should be used depending on the HCV genotype, the presence of cirrhosis and disease progression, etc. Patients should be closely monitored for efficacy and side effects, especially for patients with other diseases (including diseases other than liver disease), as they may need to take multiple drugs at the same time, so the drug interactions and possible side effects should be monitored. This way, patients can obtain good results and avoid treatment risks. In addition, patients should buy DAAs from regular sources and avoid blindly following the trend.
In the process of updating the hepatitis C guidelines this year, the panel of experts, after thorough discussion, concluded that the efficacy of DAAs is unquestionable, and that patients can purchase DAAs from countries or regions outside of mainland China, so the indications and recommendations for DAA treatment are included in the new version of the hepatitis C guidelines. Clinicians can refer to the principles and norms of use in the new hepatitis C guidelines to provide standardized guidance to patients.
Third, the accessibility and affordability of antiviral drugs are not high.
In many areas of China, interferon and ribavirin are not covered by health insurance or are reimbursed at a very low rate, resulting in many patients not actively receiving anti-hepatitis C virus (HCV) therapy after diagnosis. In addition, some of the more effective drugs, such as DAAs, are not yet available in China, and these drugs are very expensive abroad and cheaper in some neighboring regions, but it is uncertain what the future prices will be when they are available in China. Therefore, improving the accessibility and affordability of antiviral drugs is the third major challenge that China is facing.
Professor Tang Hong of West China University of Medical Sciences noted.
”We still need to do a lot of work in the future in order to achieve early diagnosis of the disease, early standardized treatment, affordable treatment, improve the cure rate of hepatitis C patients, and benefit more patients.”
DAAs are purchased abroad, require standardized treatment and follow-up, and should not be self-administered
From international studies and clinical reports, there is no doubt that DAAs are effective, especially interferon-free regimens, which not only have a shorter course but also have fewer side effects; DAAs are also suitable for some special populations, such as patients with cirrhosis, patients with contraindications to interferon therapy, liver transplant patients, and kidney transplant patients, so that more patients can benefit from them. Several international guidelines, including the WHO guidelines and those of the United States and Europe, recommend DAAs for patients with hepatitis C.
Although DAAs are not yet available in China, clinical studies of these drugs are underway in China, and they will soon be available in China. For patients who purchase DAAs from countries or regions outside of mainland China, the biggest issue is the need for standardized medication rather than patient self-administration, such as sofosbuvir, which alone can easily develop resistance and negatively impact subsequent treatment.
Doctors should advise patients who are ready to purchase DAAs that although there are internationally recommended treatment regimens for DAAs, they should seek standardized treatment and standardized follow-up with a specialist. During the treatment process, different treatment regimens should be used depending on the HCV genotype, the presence of cirrhosis and disease progression, etc. Patients should be closely monitored for efficacy and side effects, especially for patients with other diseases (including diseases other than liver disease), as they may need to take multiple drugs at the same time, so the drug interactions and possible side effects should be monitored. This way, patients can obtain good results and avoid treatment risks. In addition, patients should buy DAAs from regular sources and avoid blindly following the trend.
In the process of updating the hepatitis C guidelines this year, the panel of experts, after thorough discussion, concluded that the efficacy of DAAs is unquestionable, and that patients can purchase DAAs from countries or regions outside of mainland China, so the indications and recommendations for DAA treatment are included in the new version of the hepatitis C guidelines. Clinicians can refer to the principles and guidelines in the new Hepatitis C guideline to provide standardized guidance to their patients.