Missed Opportunities for Cure: Clinical Profile and Absence of Curative Antiviral Therapy Among Hospitalised Patients with Chronic Hepatitis C in Peshawar, Pakistan

Abstract

Background: Direct-acting antivirals (DAAs) cure more than 95% of hepatitis C virus (HCV) infections, yet only about one-fifth of infected people worldwide have been treated. Pakistan carries the largest national HCV burden. Whether admitted HCV patients are being reached by curative therapy is a critical question for elimination.Objective: To describe the clinical and biochemical profile of patients hospitalised with chronic hepatitis C at a tertiary centre in Peshawar and to determine the proportion receiving curative antiviral therapy.Methods: A cross-sectional, records-based study of 20 consecutive adults admitted with confirmed chronic HCV to the gastroenterology ward of Lady Reading Hospital, Peshawar, over 45 days. Presenting features, comorbidities, laboratory values and all prescribed medicines were recorded. The primary outcome was the proportion receiving a direct-acting antiviral. Proportions are reported with 95% confidence intervals (CIs). Results: The cohort (11 men, 9 women; most aged 51–60 years) presented overwhelmingly with the complications of decompensated cirrhosis: vomiting, abdominal pain, ascites and features of hepatic encephalopathy. Management was accordingly supportive—lactulose, rifaximin, spironolactone with furosemide and empirical third-generation cephalosporins—and one patient with hepatocellular carcinoma received sorafenib. Alanine aminotransferase was elevated in all patients measured (range 88–175 U/L), hyponatremia (<135 mmol/L) was present in 9 of 14 (64%) and thrombocytopenia in 7 of 17 (41%). Critically, no patient (0/20; 0%, 95% CI 0.0–16.1) was receiving or commenced on a curative direct-acting antiviral during admission. Conclusion: These patients reached hospital only after progression to decompensated, complication-laden disease, and none received curative antiviral therapy—an avoidable late presentation that epitomises the treatment gap Pakistan must close to meet the World Health Organization’s 2030 elimination target. Earlier screening, linkage to care and integration of DAA therapy into hospital pathways are urgently needed.

Keywords: Hepatitis C, Chronic; Antiviral Agents; Liver Cirrhosis; Health Services Accessibility; Disease Elimination; Pakistan.