Recent estimates indicate that between 130 and 150 million people worldwide have chronic hepatitis C virus (HCV) infection, and that between 350 000 and 500 000 of them die each year. Because HIV and HCV share common routes of transmission, it is estimated that 4–5 million people are coinfected with both viruses. Yet, most people infected with HCV are not aware they are infected; therefore, HCV has been called the “silent pandemic”.
Due to the complexity and cost of testing and treatment for HCV, few individuals living in resource-limited settings have access to either. It is hoped that with the introduction of new treatments for HCV in the form of direct acting antivirals (DAAs), the cost, complexity and adverse effects of HCV treatment can be reduced and that patient outcomes can be improved.
It is furthermore expected that DAAs will not only transform treatment of HCV, but that they will also make it possible to simplify the current testing regimen required for the patients with active HCV infection – reducing the number, complexity and cost of required testing. In addition, as more diagnostic tests/platforms are introduced, it is hoped that access to testing for HCV patients, from screening through to cure, will be simplified and improved. In particular, molecular platforms that are being developed for a range of infectious diseases, including HIV, for use at or near the point of patient care, could be important.
This report describes the current continuum of testing for HCV, which is complex and expensive, which means that it is very challenging to implement in resource-limited settings. It examines the platforms/tests that are currently available across the range of required HCV testing from screening to confirmation and genotyping, fibrosis staging and treatment monitoring. The report also considers how the testing cascade for HCV may be simplified with the availability of DAAs, which would help make HCV testing attainable in resource-limited settings. Finally, it looks at the pipeline of tests/platforms for HCV that could be delivered at or near the point of patient care.
This technical report was produced by UNITAID (www.unitaid.org), an organisation hosted and administered by the WHO, which uses innovative financing to increase funding for greater access to treatments and diagnostics for HIV/AIDS, malaria and tuberculosis in low-income countries.
To download the report in pdf version click in the link on the top right corner of the page.