Coppola N, Pisaturo M, Zampino R, Macera M, Sagnelli C, Sagnelli E. Hepatitis C virus markers in infection by hepatitis C virus: In the era of directly acting antivirals. World J Gastroenterol 2015; 21(38): 10749-10759 [PMID: 26478667 DOI: 10.3748/wjg.v21.i38.10749]
Corresponding Author of This Article
Nicola Coppola, MD, PhD, Assistant Professor of Infectious Diseases, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Via L. Armanni 5, 80131 Naples, Italy. nicola.coppola@unina2.it
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Topic Highlight
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nicola Coppola, Mariantonietta Pisaturo, Margherita Macera, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
Mariantonietta Pisaturo, Division of Infectious Diseases, AORN Sant’Anna e San Sebastiano di Caserta, 81100 Caserta, Italy
Rosa Zampino, Internal Medicine and Hepatology, Second University of Naples, 80131 Naples, Italy
Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery “F. Magrassi e A. Lanzara”, Second University of Naples, 80131 Naples, Italy
Author contributions: All authors substantial contributed to conception and design, acquisition of data, or analysis and interpretation of data; Coppola N contributed to drafting the article or revising it critically for important intellectual content; Pisaturo M analysis of “HCV markers in Diagnosis of chronic HCV infection and in Assessment of the severity of chronic hepatitis C”; Zampino R analysis of “HCV-RNA kinetics and clearance as markers of remission”; Macera M analysis of “Assessment of factors associated with the response to anti-viral treatment”; Sagnelli C analysis of “HCV markers in acute hepatitis C”; Sagnelli E contributed to drafting the article and revising it critically for important intellectual content; and all authors approved the final version to be published.
Conflict-of-interest statement: All the authors of the manuscript declare that they have no conflict of interest in connection with this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicola Coppola, MD, PhD, Assistant Professor of Infectious Diseases, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Via L. Armanni 5, 80131 Naples, Italy. nicola.coppola@unina2.it
Telephone: +39-815-666719 Fax: +39-815-666013
Received: April 26, 2015 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
Abstract
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.
