Kashif Malik, Har Amin M Johar, Arshad K Butt, Anwaar A Khan, Altaf Alam, Zafar Iqbal, Waqar H Shah, Farzana Shafqat.
Optimal Utilization of Prime Minister Funds for Treatment of Hepatitis C.
Proceeding Shaikh Zayed Postgrad Med Comp Jan ;23(2):61-7.

Hepatitis C virus infection is one of the major causes of chronic liver diseases throughout the world. In Pakistan, 10 million people are presumed to be infected with this disease. Hepatitis C virus has been characterized by having a higher rate of spontaneous mutation that leads to a marked degree of heterogeneity among its genotypes. HCV genotype plays an important role in the management of chronic hepatitis C. Knowing the genotype helps to decide about the duration, as well as to predict the response to treatment. But it is an expensive test, and not affordable for majority of patients. HCV RNA by PCR testing is advisable at various stages during the therapy. Early viral response (EVR) is to check the HCV RNA by PCR at 12 weeks, End of treatment response (ETR) is to do the testing at the end of treatment, while Sustained viral Response (SVR) means HCV RNA by PCR testing six months after completion of therapy. All these tests i.e. HCV genotype, EVR, ETR and SVR were checked in these patients. Aims & Objectives: The primary objective is to evaluate the proper utilization of Government funded program for the treatment of hepatitis C. Also it was aimed to determine the type of HCV genotypes as well as subtype in chronic hepatitis C patients, to check EVR, ETR and SVR in these patients, and to evaluate the cost effectiveness of these tests. A total of 1000 patients of hepatitis C virus were recruited. Results: Out of 1000 patients, 506 (50.6%) were males, while 494 (49.4%) were females. The age ranged from 16 to 67 years with a predominantly larger proportion of younger patients. HCV genotype was checked in 295 patients Genotypes 1, 2, 3, mixed and untypeable were found in these patients. The predominant genotype was 3 (84%) and its subtype 3a (71%). Early Viral Response (EVR) was checked in 142 (14.2%) patients; it was achieved in 97 patients. End of treatment response (ETR) was checked in 609 (60.9%) patients, it was achieved in 405 (66.50). HCV RNA reports to confirm the SVR were available for only 60 (6%) of patients. Out of these 60, SVR was achieved in 46 (76.66%). Conclusion: Genotypes 2 & 3 were detected in almost 90%, while other types collectively detected in rest 10% of screened patients. Although 61% patients reported with HCV RNA reports at the end of treatment, but only 6% patients opted for follow up HCV RNA by PCR testing to look for SVR. Considering the huge cost of treatment of from government funds, measures should be adopted to have a structured program for proper evaluation of these patients before, during and after the treatment. Because of its financial implications, genotype testing is not advisable for naïve patients of chronic hepatitis C.

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