title: Simplified diagnostic monitoring for hepatitis C, in the new era of direct-acting antiviral treatment.
abstract: OBJECTIVE
  Approximately 150-175 million people are infected with hepatitis C virus (HCV). Until very recently, the complexity, cost and poor efficacy and tolerability of pegylated interferon and ribavirin (PEG-RBV) treatment have hindered scale up in low-income and middle-income countries (L&MICs). Similarly, the diagnostic and monitoring algorithm associated with PEG-RBV has been expensive and complicated because of the poor efficacy and frequency of adverse drug effects of PEG-RBV therapy. This article provides an overview of the potential changes to the diagnosis and monitoring algorithm and describes key promising tools in the diagnostics pipeline.
  
  
  RESULTS
  Interferon-free direct-acting antiviral (DAA) therapy sets the stage to significantly simplify laboratory requirements and make the overall diagnostic package much less expensive. Diagnostic simplification and cost-reduction will be key to enable implementation of HCV screening and treatment in L&MICs.
  
  
  CONCLUSIONS
  There is the potential to introduce simplified monitoring for hepatitis C. Antigen testing could be used as a replacement for HCV RNA PCR tests, to establish active infection and then to prove cure after stopping DAA treatment. If new DAA treatments can be shown to be pan-genotypic, genotyping may no longer be required.
authors.affiliation: aDivision of Infectious Diseases, University of Pennsylvania bMédecins Sans Frontières, Geneva, Switzerland cDivision of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA dDepartment of Hepatology, St Mary's Hospital, Imperial College, London, London eDepartment of Pharmacology and Therapeutics, Liverpool University, Liverpool, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cohn
authors.forename: Teri
authors.initials: T
authors.lastname: Roberts
authors.forename: Valerianna
authors.initials: V
authors.lastname: Amorosa
authors.forename: Maud
authors.initials: M
authors.lastname: Lemoine
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000639:trends; D016903:Drug Monitoring / Q000379:methods* / Q000639:trends; D060005:Genotyping Techniques / Q000379:methods; D018936:Hepatitis C Antigens / Q000097:blood; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D012367:RNA, Viral / Q000097:blood
chemical_list: D000998:Antiviral Agents; D018936:Hepatitis C Antigens; D012367:RNA, Viral