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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, and whether hospitalised patients are 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-care hospital in Pakistan and to determine the proportion receiving curative antiviral therapy.
Methods: A cross-sectional, records-based study of 20 consecutive adults with confirmed chronic HCV admitted to a gastroenterology ward over 45 days. Presenting features, comorbidities, laboratory values and all prescribed medicines were recorded. The primary outcome was the proportion receiving a DAA. Proportions are reported with 95% confidence intervals (CIs).
Results: The cohort (11 men, 9 women; most aged 51–60 years) presented predominantly with complications of decompensated cirrhosis: vomiting, abdominal pain, ascites and features of hepatic encephalopathy. Management was 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), hyponatraemia (<135 mmol/L) was present in 9 of 14 (64%) and thrombocytopenia in 7 of 17 (41%). No patient (0/20; 0%, 95% CI 0.0–16.1) was receiving or commenced on a DAA during admission.
Conclusion: Patients reached hospital only after progression to decompensated 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.