Browsing by Author "Vivek A. Saraswat"

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2019 Update of Indian National Association for Study of the Liver Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri II Recommendations
(Elsevier B.V., 2020) Ashish Kumar; Subrat K. Acharya; Shivaram P. Singh; Anil Arora; Radha K. Dhiman; Rakesh Aggarwal; Anil C. Anand; Prashant Bhangui; Yogesh K. Chawla; Siddhartha Datta Gupta; Vinod K. Dixit; Ajay Duseja; Naveen Kalra; Premashish Kar; Suyash S. Kulkarni; Rakesh Kumar; Manoj Kumar; Ram Madhavan; V.G. Mohan Prasad; Amar Mukund; Aabha Nagral; Dipanjan Panda; Shashi B. Paul; Padaki N. Rao; Mohamed Rela; Manoj K. Sahu; Vivek A. Saraswat; Samir R. Shah; Shalimar; Praveen Sharma; Sunil Taneja; Manav Wadhawan
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality, and healthcare expenditure in patients with chronic liver disease in India. The Indian National Association for Study of the Liver (INASL) had published its first guidelines on diagnosis and management of HCC (The Puri Recommendations) in 2014, and these guidelines were very well received by the healthcare community involved in diagnosis and management of HCC in India and neighboring countries. However, since 2014, many new developments have taken place in the field of HCC diagnosis and management, hence INASL endeavored to update its 2014 consensus guidelines. A new Task Force on HCC was constituted that reviewed the previous guidelines as well as the recent developments in various aspects of HCC that needed to be incorporated in the new guidelines. A 2-day round table discussion was held on 5th and 6th May 2018 at Puri, Odisha, to discuss, debate, and finalize the revised consensus statements. Each statement of the guideline was graded according to the Grading of Recommendations Assessment Development and Evaluation system with minor modifications. We present here the 2019 Update of INASL Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri-2 Recommendations. © 2019
Consensus statement of HCV task force of the Indian National Association for Study of the Liver (INASL). Part I: Status report of HCV infection in India
(Elsevier, 2014) Pankaj Puri; Anil C. Anand; Vivek A. Saraswat; Subrat K. Acharya; Radha K. Dhiman; Rakesh Aggarwal; Shivram P. Singh; Deepak Amarapurkar; Anil Arora; Mohinish Chhabra; Kamal Chetri; Gourdas Choudhuri; Vinod K. Dixit; Ajay Duseja; Ajay K. Jain; Dharmesh Kapoorz; Premashis Kar; Abraham Koshy; Ashish Kumar; Kaushal Madan; Sri P. Misra; Mohan V.G. Prasad; Aabha Nagral; Amarendra S. Puri; R. Jeyamani; Sanjiv Saigal; Shiv K. Sarin; Samir Shah; P.K. Sharma; Ajit Sood; Sandeep Thareja; Manav Wadhawan
Globally, around 150 million people are infected with hepatitis C virus (HCV). India contributes a large proportion of this HCV burden. The prevalence of HCV infection in India is estimated at between 0.5% and 1.5%. It is higher in the northeastern part, tribal populations and Punjab, areas which may represent HCV hotspots, and is lower in western and eastern parts of the country. The predominant modes of HCV transmission in India are blood transfusion and unsafe therapeutic injections. There is a need for large field studies to better understand HCV epidemiology and identify high-prevalence areas, and to identify and spread awareness about the modes of transmission of this infection in an attempt to prevent disease transmission. © 2014 INASL.
Consensus statement of HCV task force of the Indian National Association for Study of the Liver (INASL). Part II: INASL recommendations for management of HCV in India
(Elsevier, 2014) Pankaj Puri; Anil C. Anand; Vivek A. Saraswat; Subrat K. Acharya; Shiv K. Sarin; Radha K. Dhiman; Rakesh Aggarwal; Shivaram P. Singh; Deepak Amarapurkar; Anil Arora; Mohinish Chhabra; Kamal Chetri; Gourdas Choudhuri; Vinod K. Dixit; Ajay Duseja; Ajay K. Jain; Dharmesh Kapoor; Premashis Kar; Abraham Koshy; Ashish Kumar; Kaushal Madan; Sri P. Misra; Mohan V.G. Prasad; Aabha Nagral; Amarendra S. Puri; R. Jeyamani; Sanjiv Saigal; Samir Shah; Praveen K. Sharma; Ajit Sood; Sandeep Thareja; Manav Wadhawan
The estimated prevalence of hepatitis C virus (HCV) infection in India is between 0.5 and 1.5% with hotspots showing much higher prevalence in some areas of northeast India, in some tribal populations and in certain parts of Punjab. Genotype 3 is the most prevalent type of infection. Recent years have seen development of a large number of new molecules that are revolutionizing the treatment of hepatitis C. Some of the new directly acting agents (DAAs) like sofosbuvir have been called game-changers because they offer the prospect of interferon-free regimens for the treatment of HCV infection. These new drugs have not yet been approved in India and their cost and availability is uncertain at present. Till these drugs become available at an affordable cost, the treatment that was standard of care for the whole world before these newer drugs were approved should continue to be recommended. For India, cheaper options, which are as effective as the standard-of-care (SOC) in carefully selected patients, are also explored to bring treatment within reach of poorer patients. It may be prudent to withhold treatment at present for selected patients with genotype 1 or 4 infection and low levels of fibrosis (F1 or F2), and for patients who are non-responders to initial therapy, interferon intolerant, those with decompensated liver disease, and patients in special populations such as stable patients after liver and kidney transplantation, HIV co-infected patients and those with cirrhosis of liver. © 2014 INASL.
Erratum: Corrigendum to “Indian National Association for Study of the Liver (INASL) guidance for antiviral therapy against HCV infection: Update 2016” (Journal of Clinical and Experimental Hepatology (2016) 6(2) (119–145) (S0973688316302584) (10.1016/j.jceh.2016.07.001))
(Elsevier B.V., 2016) Pankaj Puri; Vivek A. Saraswat; Radha K. Dhiman; Anil C. Anand; Subrat K. Acharya; Shivaram P. Singh; Yogesh K. Chawla; Deepak N. Amarapurkar; Ajay Kumar; Anil Arora; Vinod K. Dixit; Abraham Koshy; Ajit Sood; Ajay Duseja; Dharmesh Kapoor; Kaushal Madan; Anshu Srivastava; Ashish Kumar; Manav Wadhawan; Amit Goel; Abhai Verma; Shalimar; Gaurav Pandey; Rohan Malik; Swastik Agrawal
The authors regret for the typological error in Table 3 published in the original version of the article. The corrected version of Table 3 is given below: The authors would like to apologise for any inconvenience caused. © 2016
INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids
(Elsevier B.V., 2018) Anil Arora; Anil C. Anand; Ashish Kumar; Shivaram P. Singh; Rakesh Aggarwal; Radha K. Dhiman; Shyam Aggarwal; Seema Alam; Pradeep Bhaumik; Vinod K. Dixit; Ashish Goel; Bhabadev Goswami; Ashok Kumar; Manoj Kumar; Kaushal Madan; Natarajan Murugan; Aabha Nagral; Amarender S. Puri; Padaki N. Rao; Neeraj Saraf; Vivek A. Saraswat; Sanjeev Sehgal; Praveen Sharma; Koticherry T. Shenoy; Manav Wadhawan
Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids is emerging to be an important cause of morbidity and mortality in patients with current or prior exposure to HBV infection. These patients suffer a dual onslaught of illness: one from the primary disease for which they are receiving the culprit drug that led to HBV reactivation, and the other from HBV reactivation itself. The HBV reactivation not only leads to a compromised liver function, which may culminate into hepatic failure; it also adversely impacts the treatment outcome of the primary illness. Hence, identification of patients at risk of reactivation before starting these drugs, and starting treatment aimed at prevention of HBV reactivation is the best strategy of managing these patients. There are no Indian guidelines on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids for the treatment of rheumatologic conditions, malignancies, inflammatory bowel disease, dermatologic conditions, or solid-organ or bone marrow transplantation. The Indian National Association for Study of the Liver (INASL) had set up a taskforce on HBV in 2016, with a mandate to develop consensus guidelines for management of various aspects of HBV infection, relevant to India. In 2017 the taskforce had published the first INASL guidelines on management of HBV infection in India. In the present guidelines, which are in continuation with the previous guidelines, the issues on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids are addressed. © 2018
INASL-ISN Joint Position Statements on Management of Patients with Simultaneous Liver and Kidney Disease
(Elsevier B.V., 2021) Anil Arora; Ashish Kumar; Narayan Prasad; Ajay Duseja; Subrat K. Acharya; Sanjay K. Agarwal; Rakesh Aggarwal; Anil C. Anand; Anil K. Bhalla; Narendra S. Choudhary; Yogesh K. Chawla; Radha K. Dhiman; Vinod K. Dixit; Natarajan Gopalakrishnan; Ashwani Gupta; Umapati N. Hegde; Sanjiv Jasuja; Vivek Jha; Vijay Kher; Ajay Kumar; Kaushal Madan; Rakhi Maiwall; Rajendra P. Mathur; Suman L. Nayak; Gaurav Pandey; Rajendra Pandey; Pankaj Puri; Ramesh R. Rai; Sree B. Raju; Devinder S. Rana; Padaki N. Rao; Manish Rathi; Vivek A. Saraswat; Sanjiv Saxena; Shalimar; Praveen Sharma; Shivaram P. Singh; Ashwani K. Singal; Arvinder S. Soin; Sunil Taneja; Santosh Varughese
Renal dysfunction is very common among patients with chronic liver disease, and concomitant liver disease can occur among patients with chronic kidney disease. The spectrum of clinical presentation and underlying etiology is wide when concomitant kidney and liver disease occur in the same patient. Management of these patients with dual onslaught is challenging and requires a team approach of hepatologists and nephrologists. No recent guidelines exist on algorithmic approach toward diagnosis and management of these challenging patients. The Indian National Association for Study of Liver (INASL) in association with Indian Society of Nephrology (ISN) endeavored to develop joint guidelines on diagnosis and management of patients who have simultaneous liver and kidney disease. For generating these guidelines, an INASL-ISN Taskforce was constituted, which had members from both the societies. The taskforce first identified contentious issues on various aspects of simultaneous liver and kidney diseases, which were allotted to individual members of the taskforce who reviewed them in detail. A round-table meeting of the Taskforce was held on 20–21 October 2018 at New Delhi to discuss, debate, and finalize the consensus statements. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system with minor modifications. The strength of recommendations (strong and weak) thus reflects the quality (grade) of underlying evidence (I, II, III). We present here the INASL-ISN Joint Position Statements on Management of Patients with Simultaneous Liver and Kidney Disease. © 2020 Indian National Association for Study of the Liver
Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection in 2015
(Elsevier B.V., 2015) Pankaj Puri; Anil C. Anand; Vivek A. Saraswat; Subrat K. Acharya; Radha K. Dhiman; Shiv K. Sarin; Shivaram P. Singh; Yogesh K. Chawla; Rakesh Aggarwal; Deepak Amarapurkar; Anil Arora; Vinod K. Dixit; Ajit Sood; Samir Shah; Ajay Duseja; Dharmesh Kapoor; Shalimar; Kaushal Madan; Gaurav Pande; Aabha Nagral; Premashis Kar; Abraham Koshy; Amarender S. Puri; C.E. Eapen; Sandeep Thareja
Overall prevalence of HCV infection in India has been estimated to be approximately 1.3% in the general population. Recent introduction of sofosbuvir in India at a relatively affordable price has led to great optimism about prospects of cure for these patients. This drug is likely to form the backbone of current and future treatment regimes for HCV infection, displacing pegylated interferon. Availability of directly acting antiviral drugs (DAAs) has necessitated revision of INASL guidelines for the treatment of HCV published in 2014, as has happened across the world. Current considerations for the treatment of HCV in India include the poorer response of genotype 3, nonavailability of many of the DAAs recommended by other guidelines and the cost of therapy. Since only one DAA, sofosbuvir, is available in India, only two sofosbuvir-based regimes are possible: either dual drug therapy in combination with ribavirin alone for 6 months or triple drug therapy in combination with ribavirin and pegylated interferon for 3 months. The utility of these regimes in various situations has been discussed. Availability of a few other newer DAAs, expected in 2016, is expected to lead to more widespread use of these agents. Current guidance will be updated once newer DAAs, newer evidence with DAAs and 'real-life experience' with use of DAAs accumulate in India. © 2015 INASL.
Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016
(Elsevier B.V., 2016) Pankaj Puri; Vivek A. Saraswat; Radha K. Dhiman; Anil C. Anand; Subrat K. Acharya; Shivaram P. Singh; Yogesh K. Chawla; Deepak N. Amarapurkar; Ajay Kumar; Anil Arora; Vinod K. Dixit; Abraham Koshy; Ajit Sood; Ajay Duseja; Dharmesh Kapoor; Kaushal Madan; Anshu Srivastava; Ashish Kumar; Manav Wadhawan; Amit Goel; Abhai Verma; Shalimar; Gaurav Pandey; Rohan Malik; Swastik Agrawal
India contributes significantly to the global burden of HCV. While the nucleoside NS5B inhibitor sofosbuvir became available in the Indian market in March 2015, the other directly acting agents (DAAs), Ledipasvir and Daclatasvir, have only recently become available in the India. The introduction of these DAA in India at a relatively affordable price has led to great optimism about prospects of cure for these patients as not only will they provide higher efficacy, but combination DAAs as all-oral regimen will result in lower side effects than were seen with pegylated interferon alfa and ribavirin therapy. Availability of these newer DAAs has necessitated revision of INASL guidelines for the treatment of HCV published in 2015. Current considerations for the treatment of HCV in India include the poorer response of genotype 3, nonavailability of many of the DAAs recommended by other guidelines and the cost of therapy. The availability of combination DAA therapy has simplified therapy of HCV with decreased reliance of evaluation for monitoring viral kinetics or drug related side effects. © 2016 INASL