Hepatitis C is more dreaded than other hepato-centric viruses because they are more complex, have several genetic variants, more often lead to chronic infection(>90%) and cause liver cancer in about 20% in the long term. Traditional therapies include interferon injections and Ribavarin. The sustained viral response with this treatment was on an average 60% across the genotypes. Many who respond initially tend to have rebound viraemia due to resistance developed by the virus. Further both Interferon and Ribavarin have moderate to severe side effects and hence patient compliance as well as medical contraindications tend to cut short the duration of treatment.
Sofosbuvir, is set to change the way viral hepatitis is being treated. For starters it is a potent antiviral agent and achieves SVR within three months. It also boasts very few side effects and hence the compliance rate will be high. It is an orally administered medication with once a day dosing. It is equally effective against all genotypes from 1 to 6. However like other anivirals, hepatitis C can develop resistance to Sofosbuvir. Hence whenever possible it is recommended to combine pegylated interferon with Sofosbuvir and treat for 3 months.
The efficacy of this drug is lesser in patients with advanced cirrhosis, hence earlier and use on naive hepatitis C positive patients respond better with SVR of 91% with 3 month combination therapy. Most of these patients who eliminate the virus within 3 months can be considered cured of the virus. The efficacy is lower when used as rescue therapy for prior treatment failure. It is very effective in reducing viral load in pre-liver transplant setting and to treat hepatitis C after liver transplantation.
This drug is now available in India and can be ordered with e-prescription through www.liverindia.com.
genotype = known genetic variants
Interferon = injectable antiviral agent
Ribavarin = oral antiviral agent