The impact of hepatitis C virus outside the liver: Evidence from Asia

Z. M. Younossi, A. Tanaka, Y. Eguchi, Y. S. Lim, M. L. Yu, N. Kawada, Y. Y. Dan, C. Brooks-Rooney, F. Negro, M. U. Mondelli

Research output: Contribution to journalArticlepeer-review


Between 80 and 115 million people worldwide are chronically infected with hepatitis C virus, with 60%-90% of these being undiagnosed. Untreated chronic hepatitis C (CHC) is associated with progressive liver disease, cirrhosis, hepatocellular carcinoma and liver-related mortality. A number of extrahepatic manifestations are also reported in CHC patients, further adding to the burden of the disease. CHC also impacts patients in terms of lower health-related quality of life, higher levels of fatigue and reduced productivity. Furthermore, the later stages of disease are costly for both healthcare systems and society. Pegylated-interferon (PEG-IFN)+ribavirin (RBV), for many years the mainstay of treatment, leads to sustained virological response (SVR) in 40%-70% of patients. However, a substantial number of patients are ineligible for treatment, and many patients fail to achieve SVR with this regimen. Furthermore, PEG-IFN+RBV leads to impairment of patient-reported outcomes during treatment, and most patients suffer from adverse events, associated with poor adherence, treatment discontinuation and treatment failure. The approval of second-generation direct-acting antivirals (DAAs) has revolutionized the treatment of CHC patients. All-oral, PEG-IFN and RBV-free regimens have higher efficacy rates, shorter treatment durations, fewer adverse events, higher adherence rates and improvement in PROs from as early as Week 4, compared to PEG-IFN+RBV regimens. The aim of this article is to review the evidence for HCV infection as a systemic disease, summarizing the impact of hepatitis C and its treatments on clinical, patient and economic outcomes, with a focus on data from Asia and Japan specifically.
Original languageEnglish
Pages (from-to)159-172
Number of pages14
JournalLiver International
Issue number2
Publication statusPublished - Feb 1 2017


  • Antiviral Agents/therapeutic use
  • Carcinoma, Hepatocellular/virology
  • Costs and Cost Analysis
  • Drug Therapy, Combination
  • Hepacivirus
  • Hepatitis C, Chronic/complications/drug therapy/epidemiology
  • Humans
  • Interferon-alpha/therapeutic use
  • Japan
  • Liver Cirrhosis/virology
  • Liver Neoplasms/virology
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Ribavirin/therapeutic use
  • Sustained Virologic Response
  • Treatment Failure
  • cost-effectiveness
  • health-related quality of life
  • hepatitis C
  • patient-reported outcomes
  • work productivity


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