India contributes significantly to the global burden of HCV. While the nucleoside NS5B inhibitor sofosbuvir became available in the Indian market in March 2015, the other directly acting agents (DAAs), Ledipasvir and Daclatasvir, have only recently become available in the India. The introduction of these DAA in India at a relatively affordable price has led to great optimism about prospects of cure for these patients as not only will they provide higher efficacy, but combination DAAs as all-oral regimen will result in lower side effects than were seen with pegylated interferon alfa and ribavirin therapy. Availability of these newer DAAs has necessitated revision of INASL guidelines for the treatment of HCV published in 2015. Current considerations for the treatment of HCV in India include the poorer response of genotype 3, nonavailability of many of the DAAs recommended by other guidelines and the cost of therapy. The availability of combination DAA therapy has simplified therapy of HCV with decreased reliance of evaluation for monitoring viral kinetics or drug related side effects.
Keywords: ALT, alanine aminotransferase; ANC, absolute neutrophil count; AST, aspartate aminotransferase; CH-C, chronic hepatitis C; CTP, Child-Turcotte-Pugh; DAA, directly acting antiviral agents; DCV, daclatasvir; EIA, enzyme immunoassay; ESRD, end-stage renal disease; EVR, early virological response; FCH, fibrosing cholestatic hepatitis; GT, genotype; HCV; HCV, hepatitis C virus; HCWs, healthcare workers; HIV, human immunodeficiency virus; INASL, Indian National Association for Study of the Liver; IU, international units; LDV, ledipasvir; LT, liver transplantation; NS, nonstructural protein; NSI, needlestick injury; PCR, polymerase chain reaction; Peg-IFNα, pegylated interferon alfa; RBV, ribavirin; RVR, rapid virological response; SOF, sofosbuvir; SVR, sustained virological response; ULN, upper limit of normal; anti-HCV, antibody to HCV; antiviral therapy; chronic hepatitis; hepatitis C virus.