Nationwide survey of specialist knowledge on current standard of care (Peg‐IFN/RBV) and barriers of care in chronic hepatitis C patients in China

Abstract

Background and Aim: Chronic hepatitis C virus (HCV) infection is the leading cause of liver diseases including cirrhosis and hepatocellular carcinoma. In China, it is a major national health problem that demands nationwide coordinated emphasis on prevention and treatment. To inform these initiatives, a nationwide survey was conducted from January to April 2015 to evaluate the knowledge, awareness, and perceived obstacles to HCV care. Methods: A sample of 1000 HCV specialists across mainland China were recruited. Respondents were asked a series of 30 open-ended single or multiple response and Likertscale questions about their HCV treatment knowledge, experience, assessment of HCV care status in China, and perceptions about treatment barriers. Results: Sixty percent of the respondents answered incorrectly to more than half of the questions on basic HCV treatment principles. Over half of them incorrectly believed that maintenance therapy should be prescribed for non-responders (72%) and longer treatment duration improved sustained viral response rates (62%), regardless of HCV RNA level changes. Sixty-six percent of them believed that HCV treatment would still be interferon-based therapy in the next 5 years in China. Patient-related barriers, in particular lack of disease awareness, were considered to be the most significant barriers to HCV care. Payer and medical-provider barriers included affordability issues, lack of reimbursement coverage for testing and treatments, and lack of referral to HCV specialists. Conclusions: Focused and intense patient and provider education should be carried out to increase awareness. More effective direct-acting antivirals should be made available and affordable in China.

Sofosbuvir plus ribavirin with or without peginterferon for the treatment of hepatitis C virus: Results from a phase 3b study in China

“…The only currently reimbursed treatment for HCV infection in China is peginterferon plus ribavirin. Despite the high prevalence of the favorable host genotype IL28B CC in China, sustained virologic response (SVR) rates in patients treated with peginterferon and ribavirin are suboptimal, ranging from 55% in patients with HCV genotype 1 to 90% in those with HCV genotype 2 or 3 . Moreover, this regimen is contraindicated in many patients and is associated with poor tolerability, especially in patients with advanced liver disease and in older patients .…”

“…This is of particular concern in China where the population is rapidly aging and many patients present with advanced liver disease at the time of diagnosis . Treatment duration in China is often longer than elsewhere due to the common use of interferon‐based maintenance therapy in non‐responder patients . There is a clear medical need for more effective and better tolerated regimens.…”

“…Despite the high prevalence of the favorable host genotype IL28B CC in China, 2,7,8 sustained virologic response (SVR) rates in patients treated with peginterferon and ribavirin are suboptimal, ranging from 55% in patients with HCV genotype 1 to 90% in those with HCV genotype 2 or 3. 5,9,10 Moreover, this regimen is contraindicated in many patients and is associated with poor tolerability, especially in patients with advanced liver disease 11 and in older patients. [12][13][14][15][16][17] This is of particular concern in China where the population is rapidly aging and many patients present with advanced liver disease at the time of diagnosis.…”

“…18 Treatment duration in China is often longer than elsewhere due to the common use of interferon-based maintenance therapy in non-responder patients. 8,9 There is a clear medical need for more effective and better tolerated regimens.…”

Genetic Variants in TNFSF4 and TNFSF8 Are Associated With the Risk of HCV Infection Among Chinese High-Risk Population

“…WHO and other international organizations have pledged to eliminate HCV infection by 2030, which is incumbent on the development of effective vaccines and therapeutics (WHO, 2018). Although direct-acting antiviral drugs (DAAs) have been effective against HCV, only 1.3% of the patients in China have received these drugs owing to their high costs (Wei et al, 2016;Li and Chung, 2019). Furthermore, the attempts to develop an HCV vaccine have been largely unsuccessful due to the high genetic variability of this virus.…”