# Identifying Gaps in the Treatment Guidelines for Hepatitis C in Peru to Meet International Standards: A Narrative Review

## TL;DR

This paper reviews and compares Peruvian hepatitis C treatment guidelines with international standards, highlighting gaps and suggesting updates for better care.

## Contribution

The study identifies specific treatment discrepancies in Peruvian guidelines compared to international recommendations and proposes necessary updates.

## Key findings

- Glecaprevir/Pibrentasvir is recommended as first-line therapy in international guidelines but not in Peruvian guidelines.
- Peruvian guidelines do not adopt current global practices for treating chronic kidney disease patients with hepatitis C.
- The paper suggests standardizing Peruvian guidelines and conducting cost-effectiveness analyses for new therapies.

## Abstract

Hepatitis C virus still represents a major cause of morbidity and mortality worldwide. In Peru, two national practice guidelines for the management of this infection were published more than 5 years ago; however, the latest breakthroughs in the treatment make it necessary to update these guidelines. We reviewed the most recent recommendations of the international guidelines and compared them with the current Peruvian guidelines. We found major differences, such as the use of Glecaprevir/Pibrentasvir as a first-line therapy, which is contemplated in the World Health Organization guideline, and recommended by American and European guidelines, but is not considered in the Peruvian guidelines. Another crucial difference lies in the management of patients with chronic kidney disease, who are treated nowadays with a variety of direct-acting antivirals, with no restrictions on the use of Sofosbuvir-based regimens in first-world countries, an approach that has not been adopted in Peru. We believe that standardization of the recommendations of the Peruvian guidelines is imperative, including the new therapeutic strategies that have emerged in recent years. We also suggest conducting a cost effectiveness analysis in the Peruvian context to allow for the implementation of new antivirals, and to achieve a better control of hepatitis C in the country.