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

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, pre, on, and posttreatment assessment, 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. Corresponding author: Prof. Michael R. Charlton, Professor of Medicine, Director Transplant Institute and Center for Liver Diseases, The University of Chicago, 5841 South Maryland Avenue, Rm M-454| Chicago, IL 60637, Email:mcharlton@medicine.bsd.uchicago.edu, Phone: 773-702-2395 Authorship page Name Contribution Michael R. Charlton Conceptualization, synopsis development, presentation of content during the consensus meeting, participated in consensus development meeting, involved in manuscript development, review and final approval of manuscript Edward John Gane Conceptualization, synopsis development, involved in manuscript development, review and final approval of manuscript Aakash Shukla, Ravi Shankar, Bekhbold Dashtseren, Davaadorj Duger, David H Muljono, Diana A Payawal, Ganbolor Jargalsaikhan, Hery D Purnomo, Ian H Cua, Irsan Hasan, Jose Sollano Jr., Khin Maung Win, Laurentius A. Lesmana, Mohammad Salih, Pham Thi Thu Thuy, Ravi Shankar, Vivek A Saraswat Participated in consensus development meeting, involved in outline development, manuscript review and finalization Conflict of interest: None to disclose Funding: The development of the consensus document was supported by an educational support from Mylan Laboratories Limited. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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