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Hepatitis C in Developing Countries

Hepatitis C in Developing Countries: Current and Future Challenges

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Contents

List of Contributors

Introduction

REFERENCES

1 - Hepatitis C Virus: Virology, Epidemiology, and Transmission

1.1 - Hepatitis C Virus: Virology and Genotypes

INTRODUCTION

EPIDEMIOLOGY OF HEPATITIS C VIRUS GENOTYPES AND GENOTYPIC VARIATIONS AROUND THE WORLD

HEPATITIS C VIRUS GENOTYPE PATTERNS IN NORTH AFRICA AND THE MIDDLE EAST

HEPATITIS C VIRUS GENOTYPE PATTERNS IN SUB-SAHARAN AFRICA

HEPATITIS C VIRUS GENOTYPE PATTERNS IN SOUTHEAST ASIA

HEPATITIS C VIRUS GENOTYPE DISTRIBUTION IN EASTERN EUROPE

HEPATITIS C VIRUS GENOTYPE PATTERNS IN THE SOUTH AMERICA

CONCLUSIONS

REFERENCES

1.2 - Epidemiology and Modes of Transmission of HCV in Developing Countries

HCV PREVALENCE IN DEVELOPING COUNTRIES

AGE AND GENDER DISTRIBUTION IN DEVELOPING COUNTRIES

MODES OF TRANSMISSION: CHANGING PATTERNS IN THE WEST AND EAST

Blood Transfusion

Injecting Drug Users

Sexual Transmission

REFERENCES

2 - The burden of Hepatitis C in Developing countries

2.1 - Public Health and Economic Burden of Hepatitis C Infection in Developing Countries

INTRODUCTION

Impact of the Modes of Transmission on the Burden of HCV in Developing Countries

Factors Maintaining Heavy Burden of HCV in Developing Countries

Economic Burden of HCV in Egypt

Other Types of Disease Burden

Impact of Barriers to Treatment Access on the Burden of HCV in Developing Countries

Economic Challenges Associated With DAAs

Primary Prevention Campaigns and the Burden of HCV

REFERENCES

2.2 - Social, Cultural, and Political Factors Influencing HCV in Developing Countries

INTRODUCTION

INFLUENCE OF SOCIAL FACTORS ON HCV TRANSMISSION IN DEVELOPING COUNTRIES

LAY PERSPECTIVE OF HCV IN DEVELOPING COUNTRIES

HEPATITIS C AND INJECTING DRUG USE: THE REALITIES OF STIGMATIZATION AND DISCRIMINATION

DISCRIMINATION TOWARD PEOPLE LIVING WITH HEPATITIS C

REFERENCES

3 - Hepatitis C Infection in Specific Geographic Regions

3.1 - Hepatitis C in Egypt

INTRODUCTION

PREVALENCE AND INCIDENCE OF HCV IN EGYPT

Prevalence

PREVALENCE OF HCV AMONG HIGH-RISK GROUPS IN EGYPT

Incidence

ACUTE HEPATITIS C IN EGYPT

MODES OF TRANSMISSION OF HCV IN EGYPT

Occupational Exposures

IMPACT OF IMMIGRATION ON HCV TRANSMISSION

ECONOMIC BURDEN OF HCV IN EGYPT

TREATMENT OF HEPATITIS C IN EGYPT IN THE ERA OF DIRECT-ACTING ANTIVIRAL AGENTS

HEPATITIS C PREVENTION STRATEGIES IN EGYPT

ABBREVIATIONS

REFERENCES

3.2 - Hepatitis C in North Africa (Arabic Maghreb Region)

INTRODUCTION

THE STATUS OF HCV IN MAGHREB REGION

PREVALENCE OF HCV IN MAGHREB COUNTRIES

HCV in Algeria

HCV in Libya

HCV in Mauritania

HCV in Morocco

HCV in Tunisia

FACTORS ASSOCIATED WITH HCV IN MAGHREB REGION

Health Care–Associated Factors

Illegal Migration, Drug Trafficking and Abusing

Level of Urbanization

STRATEGIES TO PREVENT HCV IN THE MAGHREB REGION

CONCLUSION

ABBREVIATION

REFERENCES

FURTHER READING

3.3 - Hepatitis C Virus in Sub-Saharan Africa

INTRODUCTION

HEPATITIS C VIRUS PREVALENCE IN CENTRAL AFRICA

Hepatitis C in Gabon

Hepatitis C Infection in the Democratic Republic of Congo

HCV PREVALENCE IN THE WEST AFRICAN REGION

Hepatitis C in Nigeria

HIV/HCV CO-INFECTION IN NIGERIA

HCV GENOTYPES IN NIGERIA

MODES OF HCV TRANSMISSION IN NIGERIA

HCV Infection in Mali

Hepatitis C in Burkina Faso

HCV Genotypes

Risk Factors for HCV Transmission in Sub-Saharan Africa

Unsterile Injections

Stratification and Tattooing

Heterosexual Transmission

Mother-to-Child Transmission

HCV and HIV Co-infection

REFERENCES

3.4 - Hepatitis C Virus Infection in the Indian Sub-Continent

INTRODUCTION

Natural History of Hepatitis C Virus

Primary Causes of Hepatitis

Hepatitis C Infection in the Indian Subcontinent

Safe Injection Practice Intervention in Pakistan and India

The Treatment Options for HCV

Innovative Financing Model for Free Treatment of HCV in India and Pakistan

Public Education Initiatives Against HCV

HCV IN INDIA

Population 1,308,221,797; Land Area 1,308,221,797; per Capita Income USD 1688

Incidence of HCV 0.33% (0.5%–1.5%)

Co-infection HCV and HIV

Modes of Transmission of HCV in India

HCC and HCV in India

Hemodialysis and HCV in India

HCV and HIV Burden in PWID in South India (Chennai) [9]

HCV and HIV Burden in North India (Delhi)

Lab Diagnosis of HCV in India

Treatment of HCV in India

Sixth World Hepatitis Day – July 28, 2016

HCV IN PAKISTAN

Population 194,881,548; Land Area 803,940km2; per Capita Income USD 1427.08

Incidence of HCV 6%–6.8% (rural 25%, transfusion 2.45%)

Medecins Sans Frontiers – MSF Initiative in Pakistan

Government of Pakistan Fixed the Price of “Sofosbuvir”

HCV IN MYANMAR

Population 54,363,426; Land Area 676,577km2; per Capita Income USD 824.19

Incidence of HCV 0.34%–2.3%; Disease Burden 1.30million

HCV IN AFGHANISTAN

Population 25,500,100 [16]; Land Area 645,807km2; per Capita Income USD 600

Incidence of HCV 1%–1.1%

HCV IN NEPAL

Population 26,494,504; Land Area 147,181km2; per Capita Income USD 734

Incidence of HCV 0.6%

HCV IN BANGLADESH

Population 161,468,818; Land Area 143,998km2; per Capita Income USD 1284

Incidence of HCV 0.6%

HCV IN SRI LANKA

Population 21,203,000; Land Area 65,610km2; per Capita Income USD 3818

Incidence of HCV 1.06% of blood donors

HCV IN BHUTAN

Population 780,516; Land Area 38,394km2; per Capita Income USD 2836

Incidence of HCV 1.3%

HCV IN MALDIVES

Population 393,500; Land Area 298km2; per Capita Income USD 9126

Incidence of HCV – Not Known

REFERENCES

FURTHER READING

3.5 - Hepatitis C in Developing Countries in Southeast Asia

EPIDEMIOLOGY

GEOGRAPHICAL DISTRIBUTION OF HCV GENOTYPES IN SOUTHEAST ASIA

HCV GENOTYPE 6 IN SOUTHEAST ASIA

HEPATITIS C AND HIV IN SOUTHEAST ASIA

HEPATITIS C IN VIETNAM

HCV IN MYANMAR

HCV IN INDONESIA

HCV IN PHILIPPINES

HCV IN CAMBODIA

REFERENCES

4 - Hepatitis C Coinfections and Comorbidities in Developing Countries

4.1 - Hepatitis C and Schistosomiasis Coinfection

INTRODUCTION

SCHISTOSOMA LIFE CYCLE AND MODES OF TRANSMISSION

ACUTE SCHISTOSOMIASIS

CHRONIC SCHISTOSOMIASIS

IMMUNE RESPONSES IN SCHISTOSOMIASIS

IMMUNE RESPONSES IN HEPATITIS C INFECTION

CONCOMITANT SCHISTOSOMIASIS AND HCV INFECTION

EFFECT OF SCHISTOSOMIASIS ON THE OUTCOME OF ACUTE HEPATITIS C INFECTION

EFFECT OF SCHISTOSOMIASIS ON THE PROGRESSION OF CHRONIC HEPATITIS C

REFERENCES

4.2 - Hepatitis C and Helminthic Infections

INTRODUCTION

CHARACTERISTICS OF IMMUNE RESPONSE TO HELMINTHS

Helminthic Infections Induce a Th2-Biased Immune Response in Their Hosts

Chronic Immune Activation, Hyporesponsiveness, and Anergy Associated With Helminthic Infections

Immunoregulation During Helminthic Infections

CONCURRENT HELMINTHIC AND HEPATITIS C INFECTIONS

EFFECT OF HELMINTHS ON VIRAL INFECTIONS

Effect of Helminths on Acquisition of HCV and HIV Infections

Effect of Helminths on Concomitant HIV/HCV Progression

CONCLUDING REMARKS

REFERENCES

4.3 - Hepatitis C and HIV Coinfection in Developing Countries

HIV IN DEVELOPING COUNTRIES

HIV EPIDEMIC IN SUB-SAHARAN AFRICA

HIV IN DEVELOPING COUNTRIES IN LATIN AMERICA AND THE CARIBBEAN

HEPATITIS C AND HIV COINFECTION

IMPACT OF HIV INFECTION ON CHRONIC HCV

EFFECT OF ART ON THE COURSE OF HCV

TREATMENT OF HCV WITH COEXISTING HIV INFECTION IN THE ERA OF DIRECT-ACTING ANTIVIRAL AGENTS [41–47]

Recommended HCV Treatment in Patients With HIV Coinfection

DRUG–DRUG INTERACTIONS BETWEEN ANTIRETROVIRALS AND DAAS

CONCLUSION

REFERENCES

FURTHER READING

4.4 - Hepatitis B and C Coinfection

INTRODUCTION

EPIDEMIOLOGY

VIRAL INTERACTIONS

Clinical Features of Hepatitis C and Hepatitis B Coinfection

HBV Superinfection of Patients With Chronic HCV Infection

OHB Infection in Chronic HCV Hepatitis

HBV Superinfection of Patients With Chronic HCV Hepatitis

Acute Coinfection of HBV/HCV

HCV Superinfection of Patients With Chronic HBV Infection

Evolution of Treatment of HBV/HCV Coinfected Patients

Treatment of HCV in Dually Infected HCV/HBV Patients With Chronic HCV Hepatitis

Standard Interferon With RBV for HCV/HBV Coinfection

Standard Peg-IFN With RBV for HCV/HBV Coinfection

DAAs for HCV/HBV Co-infection

Treatment of HBV in Dually Infected HCV/HBV Patients With Chronic HBV Hepatitis

Guidelines for the Treatment of Coinfected HBV/HCV Patients

REFERENCES

4.5 - Hepatitis C Infection in Patients With Hemoglobinopathies

INTRODUCTION

HEMOGLOBINOPATHIES IN DEVELOPING COUNTRIES

SC Disease

Epidemiology of SC Disease

Beta-Thalassemia

Epidemiology of Beta-Thalassemia

Alpha-Thalassemia

HEPATITIS C INFECTION IN PATIENTS WITH HEMOGLOBINOPATHIES

Epidemiology

Liver Disease Patterns in Patients With Thalassemia With HCV Infection

Treatment of HCV in Patients With Hemoglobinopathies

Interferon-Based Regimen

Treatment of Patients With Thalassemia With Chronic HCV in the Era of DAAs

REFERENCES

FURTHER READING

4.6 - Hepatitis C in Patients on Hemodialysis

INTRODUCTION

THE IMPACT OF HCV ON KIDNEY DISEASE

PREVENTION OF HCV TRANSMISSION IN HD UNITS

NATURAL COURSE OF HCV INFECTION IN PATIENTS WITH ESRD

TREATMENT OF HCV IN PATIENTS WITH ESRD

Monotherapy With Standard Interferon or Pegylated Interferon

IFN or peg-IFN With Ribavirin

Direct-Acting Antiviral Agents

REFERENCES

FURTHER READING

5 - Hepatitis C Screening and Diagnosis in Developing Countries

SCREENING OF HEPATITIS C VIRUS INFECTION

Methods of HCV Screening

Advantages of HCV Screening

Barriers to HCV Screening in Developing Countries

Diagnosis of Acute HCV

Diagnosis of Chronic HCV

Diagnostics in Developing Countries

REFERENCES

5 - Evolution of Hepatitis C Treatment

6 - Hepatitis C Treatment in the Era of Direct-Acting Antiviral Agents: Challenges in Developing Countries

INTRODUCTION

NATURAL HISTORY AND OUTCOME OF HCV INFECTION

EVOLUTION OF HCV THERAPY

DIRECT-ACTING ANTIVIRAL AGENTS

Goals of HCV and Endpoints of Treatment With DAAs

Classes of DAAs

NS3/4A Protease Inhibitors

First-Generation PIs

Second-Wave, First-Generation PIs

Second-Generation PIs

NS5B Nucleoside Polymerase Inhibitors

Sofosbuvir (SOVALDI)

Efficacy of SOF Plus PEG-IFN/RBV

Efficacy of IFN-Free SOF Regimen

SOF and SIM Combination (Olysio)

SOF With the NS5A Inhibitor Ledipasvir (Harvoni)

SOF–Velpatasvir (Epclusa)

NONSTRUCTURAL PROTEIN 5A INHIBITORS

Daclatasvir (Daklinza)

Ledipasvir

OMBITASVIR–PAITAPREVIR– RITONAVIR–DASABUVIR (VIEKIRA PAK)

Treatment of Different HCV Genotypes

HCV Genotype 1 (Fig. 6.4)

Ledipasvir–SOF Combination

SOF–VEL

EBR–GZR

SOF and Daclatasvir

Ombitasvir–Paritaprevir–Ritonavir–Dasabuvir

Genotype 2 (Fig. 6.5)

HCV Genotype 3 (Fig. 6.6)

HCV Genotype 4 (Fig. 6.7)

HCV Genotype 5 or 6 (Fig. 6.8)

PATIENTS WITH HCV AND HIV COINFECTION

TREATMENT OF PATIENTS WITH DECOMPENSATED CIRRHOSIS

PATIENTS WITH HCV RECURRENCE AFTER LIVER TRANSPLANTATION

PATIENTS WITH HCV AND RENAL IMPAIRMENT

RETREATMENT OF PATIENTS WHO FAILED PREVIOUS THERAPY [56,95,98,107,108]

TREATMENT OF HCV AND HBV COINFECTION

DAA RESISTANCE

Challenges to HCV Treatment in Developing Countries

Prevention of Hepatitis C in Developing Countries

Recombinant Viral Vaccine Vectors

Peptide Vaccines

Recombinant Protein Subunit Vaccines

DNA Vaccine

REFERENCES

FURTHER READING

WORLD BANK LIST OF COUNTRIES ACCORDINGTO ECONOMY

Index

A

B

C

D

E

F

G

H

I

K

L

M

N

O

P

R

S

T

U

V

W

Y

Z

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