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International Liver Transplantation Society Asian Consensus on the Management of Hepatitis C Virus Infection in Resource Limited Setting—From Noncirrhotic to Decompensated Disease and After Liver Transplantation

Charlton, Michael R.1; Gane, Edward J., MD2; Shukla, Aakash, MD3; Dashtseren, Bekhbold4,5; Duger, Davaadorj5; Muljono, David H., MD, PhD6,7,8,9; Payawal, Diana A., MD10; Jargalsaikhan, Ganbolor, MD4,5; Purnomo, Hery D., PhD, MD11; Cua, Ian H.12; Hasan, Irsan13,14; Sollano, Jose Jr, MD15; Win, Khin Maung16; Lesmana, Laurentius A., MD, PhD17; Salih, Mohammad, MD18; Thi Thu Thuy, Pham19; Shankar, Ravi20; Saraswat, Vivek A.21

doi: 10.1097/TP.0000000000002453
Original Clinical Science—Liver

Background. The population of Asia exceeds 4.4 billion people. Chronic hepatitis C virus (HCV) infection in Asia is characterized by specific distribution of genotypes, lack of access to specific therapeutic agents, relatively high cost of treatment, and lack of experienced healthcare providers. Clear consensus on the diagnosis, management, and monitoring of HCV infection specific to the Asian region is a major unmet need. The consensus guidelines documents that have been published to date by major medical societies presume access to an array of direct acting antiviral agents and diagnostic tests that are not broadly applicable to resource limited settings, including Asia.

Methods. To address the lack of an Asia-specific set of HCV treatment guidelines, we assembled a panel of 15 HCV experts in the field of hepatology from India, Indonesia, Myanmar, Vietnam, Pakistan, Philippines, and Mongolia convened in April 2017 to review the updated literature and provide recommendations on the diagnosis and management of chronic HCV infection that reflects local conditions.

Results. An evidence-based comprehensive compilation of the literature supported by the graded recommendations from the expert panel for the optimization of the diagnosis, pretreatment, on treatment, and posttreatment assessments, and management of chronic HCV infection has been presented in this article.

Conclusions. With the evolving treatment landscape and addition of several new direct-acting antiviral agents and combination regimens into the therapeutic armamentarium, the current article may serve as a guide to the clinicians in optimizing the diagnosis and treatment selection for the management of chronic HCV infection in resource-limited settings.

1 Transplant Institute, Center for Liver Diseases, The University of Chicago Biological Sciences, Chicago, IL.

2 New Zealand Liver Transplant Unit, Auckland City Hospital, Grafton, Auckland, New Zealand.

3 Department of Gastroenterology, LTMMC and LTMGH, Sion Mumbai, India.

4 Liver Center Clinical Research Center, Mongolia.

5 Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.

6 Eijkman Institute for Molecular Biology, Jakarta, Indonesia.

7 Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia.

8 Sydney Medical School, University of Sydney, Australia.

9 National Expert Committee for Hepatitis, Ministry of Health, Indonesia.

10 Department of Internal Medicine, Digestive Health Center, Fatima Medical University Center, Metro Manila, Philippines.

11 Division of Gastroentero-Hepatology, Department of Internal Medicine Dr Kariadi Hospital, Diponegoro University Semarang Indonesia.

12 Institute of Digestive and Liver Diseases, St. Luke’s Medical Center, Quezon City, Philippines.

13 Division of Hepatology, Department of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia.

14 Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

15 Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.

16 Department of Hepatology, University of Medicine (1), Yangon, Ministry of Health and Sports, Myanmar.

17 Department of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Teaching Hospital, Jakarta, Indonesia.

18 Department of Hepatology, Quaid e Azam International Hospital, Islamabad, Pakistan.

19 Hepatology Department, Medic Medical Center, Ho Chi Minh City, Vietnam.

20 Global Center of Excellence Lead for Infectious Disease and Head of Medical Affairs, Mylan Laboratories Ltd.

21 Department of Gastroenterology, SGPGIMS, Lucknow, India.

Received 16 October 2017. Revision received 30 May 2018.

Accepted 29 July 2018.

M.R.C. Conceptualization, synopsis development, presentation of content during the consensus meeting, participated in consensus development meeting, involved in article development, review and final approval of article. E.J.G. participated in the conceptualization, synopsis development, involved in article development, review and final approval of article. A.S., R.S., B.D., D.D., D.H.M., D.A.P., G.J., H.D.P., I.H.C., I.H., J.S.Jr., K.M.W., L.A.L., M.S., P.T.T.T., R.S., V.A.S. participated in the consensus development meeting, involved in outline development, article review and finalization.

The authors declare no conflicts of interest.

The development of the consensus document was supported by an educational support from Mylan Laboratories Limited.

Correspondence: Michael R. Charlton, Transplant Institute and Center for Liver Diseases, The University of Chicago, Rm M-454, 5841 South Maryland Ave., Chicago, IL 60637. (

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