Published online Oct 14, 2015. doi: 10.3748/wjg.v21.i38.10749
Peer-review started: April 28, 2015
First decision: June 2, 2015
Revised: July 4, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: October 14, 2015
Processing time: 171 Days and 11.6 Hours
About 130-170 million people are infected with the hepatitis C virus (HCV) worldwide and more than 350000 people die each year of HCV-related liver diseases. The combination of pegylated interferon (Peg-IFN) and ribavirin (RBV) was recommended as the treatment of choice for chronic hepatitis C for nearly a decade. In 2011 the directly acting antivirals (DAA) HCV NS3/4A protease inhibitors, telaprevir and boceprevir, were approved to treat HCV-genotype-1 infection, each in triple combination with Peg-IFN and RBV. These treatments allowed higher rates of SVR than the double Peg-IFN + RBV, but the low tolerability and high pill burden of these triple regimes were responsible for reduced adherence and early treatment discontinuation. The second and third wave DAAs introduced in 2013-2014 enhanced the efficacy and tolerability of anti-HCV treatment. Consequently, the traditional indicators for disease management and predictors of treatment response should be revised in light of these new therapeutic options. This review article will focus on the use of the markers of HCV infection and replication, of laboratory and instrumental data to define the stage of the disease and of predictors, if any, of response to therapy in the DAA era. The article is addressed particularly to physicians who have patients with hepatitis C in care in their everyday clinical practice.
Core tip: The second and third wave directly acting antivirals introduced in 2013-2014 enhanced the efficacy and tolerability of anti-hepatitis C virus (HCV) treatment. Consequently, the traditional indicators for disease management and predictors of treatment response should be revised in light of these new therapeutic options. This review article analyzes the modern use of the markers of HCV infection in: (1) the diagnosis of acute hepatitis C; (2) the diagnosis of chronic HCV infection; (3) the assessment of the severity of chronic hepatitis C; (4) the assessment of factors associated with response to anti-viral treatment; and (5) HCV-RNA kinetics and clearance as markers of remission.