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HCV management in resource-constrained countries.

Seng Gee Lim1,2

  • 1Division of Gastroenterology and Hepatology, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. mdclimsg@nus.edu.sg.

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Summary
This summary is machine-generated.

Hepatitis C virus (HCV) eradication is achievable with new direct-acting antiviral (DAA) therapies. Addressing undiagnosed cases and improving diagnosis are crucial for global HCV elimination efforts.

Keywords:
Birth cohort screeningDirect-acting antiviral agentsHCV care continuumHCV therapyLinkage to careScreening

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Area of Science:

  • Hepatology
  • Infectious Diseases
  • Public Health

Background:

  • Direct-acting antiviral (DAA) therapies offer high cure rates for Hepatitis C virus (HCV).
  • Generic DAAs improve access in resource-constrained settings, but therapy is only one part of the HCV care continuum.
  • A significant number of undiagnosed HCV cases remain a major barrier to eradication.

Purpose of the Study:

  • To review the current landscape of Hepatitis C virus (HCV) management, focusing on challenges and strategies for eradication.
  • To highlight the importance of improving diagnosis and linkage to care within the HCV care continuum.
  • To discuss the role of direct-acting antiviral (DAA) therapies and their accessibility in resource-limited settings.

Main Methods:

  • Review of current HCV treatment guidelines and therapeutic options.
  • Analysis of diagnostic challenges and potential improvements, including point-of-care testing.
  • Examination of public health strategies, such as HCV notification, and their impact on diagnosis and care.
  • Evaluation of non-invasive markers for cirrhosis assessment.
  • Discussion of generic and pangenotypic DAA regimens for various HCV genotypes.

Main Results:

  • Suboptimal risk factor screening identifies less than 20% of known HCV cases, necessitating improved diagnostic strategies.
  • HCV notification policies can increase diagnosis rates (e.g., 75% in Australia) and improve linkage to care.
  • Non-invasive markers for cirrhosis evaluation show only moderate accuracy.
  • Generic DAA combinations (sofosbuvir, ribavirin, ledipasvir, or daclatasvir) are effective for all genotypes, with pangenotypic regimens like sofosbuvir/velpatasvir emerging.

Conclusions:

  • HCV eradication is increasingly feasible due to effective direct-acting antiviral (DAA) therapies.
  • Improving HCV diagnosis rates and linkage to care are critical unmet needs.
  • Despite challenges in resource-constrained settings, concerted efforts can significantly advance HCV elimination goals.