• 1 Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore. Electronic address:
  • 2 UOC Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  • 3 Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University School of Medicine, Taipei, Taiwan
  • 4 Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
  • 5 New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
  • 6 Hepatology Division, Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia
  • 7 Stanford University Hospitals and Clinics, Palo Alto, CA, USA
  • 8 Department of Gastroenterology, Mount Elizabeth Medical Centre, Singapore, Singapore
  • 9 Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Xicheng, Beijing, China
  • 10 NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
  • 11 Department of Hepatology, Institute of Liver Disease, HPB Surgery and Transplant, Global Hospital, Parel, Mumbai, India
  • 12 Liver Institute of Virginia, Bon Secours Health System, Richmond, VA, USA
  • 13 Department of Medicine III, University Hospital Aachen, Aachen, Germany
  • 14 Department of Hepatology, Selayang Hospital, Selangor, Malaysia
  • 15 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok-noi, Bangkok, Thailand
  • 16 Yangon GI and Liver Centre, Pabedan, Yangon, Myanmar
  • 17 Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
Lancet Gastroenterol Hepatol, 2017 01;2(1):52-62.
PMID: 28404015 DOI: 10.1016/S2468-1253(16)30080-2


The Asia-Pacific region has disparate hepatitis C virus (HCV) epidemiology, with prevalence ranging from 0·1% to 4·7%, and a unique genotype distribution. Genotype 1b dominates in east Asia, whereas in south Asia and southeast Asia genotype 3 dominates, and in Indochina (Vietnam, Cambodia, and Laos), genotype 6 is most common. Often, availability of all-oral direct-acting antivirals (DAAs) is delayed because of differing regulatory requirements. Ideally, for genotype 1 infections, sofosbuvir plus ledipasvir, sofosbuvir plus daclatasvir, or ombitasvir, paritaprevir, and ritonavir plus dasabuvir are suitable. Asunaprevir plus daclatasvir is appropriate for compensated genotype 1b HCV if baseline NS5A mutations are absent. For genotype 3 infections, sofosbuvir plus daclatasvir for 24 weeks or sofosbuvir, daclatasvir, and ribavirin for 12 weeks are the optimal oral therapies, particularly for patients with cirrhosis and those who are treatment experienced, whereas sofosbuvir, pegylated interferon, and ribavirin for 12 weeks is an alternative regimen. For genotype 6, sofosbuvir plus pegylated interferon and ribavirin, sofosbuvir plus ledipasvir, or sofosbuvir plus ribavirin for 12 weeks are all suitable. Pegylated interferon plus ribavirin has been replaced by sofosbuvir plus pegylated interferon and ribavirin, and all-oral therapies where available, but cost and affordability remain a major issue because of the absence of universal health coverage. Few patients have been treated because of multiple barriers to accessing care. HCV in the Asia-Pacific region is challenging because of the disparate epidemiology, poor access to all-oral therapy because of availability, cost, or regulatory licensing. Until these problems are addressed, the burden of disease is likely to remain high.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.