Approximately 8.8 million people are living with chronic hepatitis C virus (HCV) in Pakistan. We assessed factors related to health-related quality of life (HRQoL) among the general population screened for HCV and calculated the national burden in quality-adjusted life years (QALYs). A cross-sectional study was conducted in community and clinic-based settings in Karachi and Gujranwala. HRQoL was assessed before diagnosis using EQ-5D-3L (Pakistan value set). Propensity score matching (PSM) was used to address socio-economic differences between HCV RNA-positive (viraemic) and HCV-antibody-negative participants. We assessed socio-demographic and HCV-related predictors of HRQoL (Tobit regression) and problems by EQ-5D domain (logistic regression). The HCV transmission model was used to estimate the burden of HCV in terms of morbidity- and mortality-related QALY loss in 2024. After PSM, 778 individuals remained in each group from a total of 5468 participants. HCV-positive participants had lower HRQoL (EQ-5D-3L score, p < 0.001) and higher odds of problems in all five EQ-5D dimensions. Lower HRQoL was associated with older age and unemployment, while married or Urdu-speaking participants had higher HRQoL. There was little evidence that cirrhosis was associated with HRQoL (p = 0.140) among HCV-positive participants. The total estimated QALY loss due to HCV in Pakistan in 2024 was 804,580 QALYs, of which 55% was due to mortality. HCV infection is associated with reduced HRQoL and substantial QALY losses in Pakistan. Our findings emphasise the role of socio-demographic variables on HRQoL. Further research in Pakistan is needed to determine if HCV treatment can mitigate these effects.

Pakistan has the largest national burden of hepatitis C virus (HCV) infections (9.8 million). High levels of testing and treatment are needed to achieve HCV elimination, but little data exists on this in Pakistan. A household sero-survey from Sindh province (2019-2020) collected self-reported data from adults on previous HCV testing and treatment, and undertook HCV-antibody (HCV-Ab) testing of participants (2988 children (<18) and 3684 adults) and HCV-RNA testing of HCV-Ab positive individuals. We determined the self-reported HCV cascade-of-care among adults ever eligible for HCV treatment, defined as either having a past infection (HCV-Ab positive and HCV-RNA negative) with self-reported treatment history or current infection (HCV-RNA positive). We assessed factors associated with self-reporting ever being HCV-tested using multi-variable logistic regression. Overall, 10.8% (397/3684) of adults tested HCV Ab-positive in the sero-survey, of which 80.9% (321/397) had a HCV-RNA test result. Of adults defined as ever treatment eligible (n = 232), 40.9% (95/232) reported a previous HCV test and 91.2% (87/95) reported testing positive. Of these, HCV treatment was reported by 69.0% (60/87) and 46.7% (28/60) of treated individuals tested HCV-RNA-negative. Overall, 25.9% (60/232) of treatment-eligible adults reported being treated. The regression analysis suggested that males, older adults (>25 years), and adults with a secondary or higher education level were more likely to have ever been tested for HCV, as were individuals with a family history of hepatitis, received HBV vaccination or that had various risk factors linked to HCV transmission (e.g., blood transfusion, having tattoo/acupuncture, hospitalisation or therapeutic injection (s) history). The cascade-of-care for HCV needs improving to eliminate HCV in Pakistan, especially among younger adults, women and people with low education levels.

Detection of viral RNA is essential for hepatitis C virus (HCV) diagnosis. Collection and preservation of plasma, the preferred specimen type, is challenging in some areas. The Cobas Plasma Separation Card (PSC) is an alternative specimen type with no cold chain requirements. The PSC is designed to use capillary blood from fingerstick and capillary tube collection, but alternative sample collection options would broaden PSC utility. This study explored qualitative and quantitative HCV RNA detection with PSC prepared using a syringe needle, compared to plasma. Using a 24-gauge syringe, blood was drawn by venipuncture from HCV antibody-positive clinic patients aged > 18 years and used to prepare plasma or spotted directly onto three PSCs using 6, 8 and 10 drops per spot (group 1) or 8, 10 and 12 drops (group 2). HCV RNA was measured using the Cobas HCV assay. Test results for all conditions were available for 143 patients in group 1 and 109 patients in group 2. The proportions with detectable HCV RNA were not significantly different from plasma, and overall agreement was over 88% for any PSC spot number (Fisher exact test p > 0.1). The mean HCV viral load was lower for PSC samples vs. plasma for six or eight spots in group 1 but not statistically different for 10 or 12 spots in either group. Direct spotting of blood using a syringe is a viable alternative to finger prick and capillary tube transfer for PSC preparation. This approach may be beneficial in resource-limited settings and in patient populations for whom capillary blood collection is challenging.

Hepatitis B and C are serious viral infections that cancause liver damage and death. According to the WorldHealth Organization (WHO), there are currently 2.8 millionpeople living with hepatitis B in Pakistan, and 9.8 millionpeople living with hepatitis C.1 These numbers representa significant burden of disease for the country. Thecurrent prevalence of hepatitis B in Pakistan is 1.1%,which corresponds to one-quarter of the burden of thedisease in the Eastern Mediterranean region.1 Theprevalence of hepatitis C is 7.5%, which is the highest inthe world. Almost 37,000 people die each year in Pakistandue to hepatitis B and C.2 The high prevalence of hepatitisB and C in Pakistan is a major public health concern. Theseinfections can lead to serious health complications,including liver cancer and cirrhosis. The economic cost ofhepatitis in Pakistan is also significant, due to lostproductivity and healthcare expenses. Continued...

Primary non-response to the currently available direct acting anti-viral (DAAs) in chronic hepatitis C virus (HCV) is rare and expected in approximately only 3-4% of the patients. Among the plausible explanations, HCV resistant variant may be one of the causes among the several other viral and host factors implicated in cases who do not achieve cure. Ever since the approval of licensed DAAs in 2014, focus has been mainly on high cure rates. Hence, significantly less attention has been given to the few difficult to treat cases. We present, herein, the case of a 50-year old male who had previously failed to respond to the currently available first and second-line DAA treatment and was then approved for a special treatment access programme. According to our knowledge this is the first case-report from Pakistan in favour of the physician’s directive for special treatment access for HCV DAA-experienced patients. Keywords: Hepatitis C virus, Direct acting anti-virals, Standard of care, Pakistan.

The World Health Organization (WHO) has designated the year 2030 as a landmark year for "Viral Hepatitis Elimination". Among the WHO member states, Pakistan has the largest chronic hepatitis C (CHC) infected population and like other countries, Pakistan is also striving for the hepatitis C elimination goal. Baseline screening is the mainstay of dealing with this public health challenge. Innovative interventions are needed, to achieve this goal, such as scale-up of the baseline screening using rapid anti-HCV tests, which can later be followed by HCV RNA. All those who test positive for HCV RNA, require treatment to enable us to reach the milestone of 'Hepatitis C elimination by year 2030'. The modeling done by the CDA to determine the number of people to be tested and treated alongside the support for HCV elimination coming from the Prime Minister's (PM) programme in Pakistan are all the factors, which when put together, show that we might achieve the testing, treatment and cure for those who are currently infected. The yearly addition of new HCV infections may prove to be a major barrier in achieving HCV elimination. Therefore, timely prevention of new infections has to be our number one priority. This article is based on the webinar presentation, made by Dr. Huma Qureshi on the theme of Hepatitis C eradication, in the KEMCA UK Universal Healthcare Programme.