We compared the cost-benefit of two algorithms, recently proposed by the Centers for Disease Control and Prevention, USA, with the conventional one, the most appropriate for the diagnosis of hepatitis C virus (HCV) infection in the Brazilian population. Serum samples were obtained from 517 ELISA-positive or -inconclusive blood donors who had returned to Fundação Pró-Sangue/Hemocentro de São Paulo to confirm previous results. Algorithm A was based on signal-to-cut-off (s/co) ratio of ELISA anti-HCV samples that show s/co ratio ≥95% concordance with immunoblot (IB) positivity. For algorithm B, reflex nucleic acid amplification testing by PCR was required for ELISA-positive or -inconclusive samples and IB for PCR-negative samples. For algorithm C, all positive or inconclusive ELISA samples were submitted to IB. We observed a similar rate of positive results with the three algorithms: 287, 287, and 285 for A, B, and C, respectively, and 283 were concordant with one another. Indeterminate results from algorithms A and C were elucidated by PCR (expanded algorithm) which detected two more positive samples. The estimated cost of algorithms A and B was US$21,299.39 and US$32,397.40, respectively, which were 43.5 and 14.0% more economic than C (US$37,673.79). The cost can vary according to the technique used. We conclude that both algorithms A and B are suitable for diagnosing HCV infection in the Brazilian population. Furthermore, algorithm A is the more practical and economical one since it requires supplemental tests for only 54% of the samples. Algorithm B provides early information about the presence of viremia.

Hepatitis C virus (HCV) is a blood-borne infection and one of the most important global health problems at present. This infection is the most common cause of liver transplantation in the USA, and is associated with significant morbidity, mortality, and high health care costs. Although children represent a fraction of the total infected population, pediatric HCV is a condition with an important health impact. The natural history of pediatric HCV is not fully understood. While most young patients are characterized by having mild liver disease during childhood, many have moderate and some have advanced fibrosis even early on in life. The factors that determine these differences have not been established. There have been significant advances with regard to treatment of HCV infection among adults over the last few years. Management of affected children has also improved and is expected to achieve a sustained virologic response in the majority of patients treated in the near future. This review discusses the epidemiology and present knowledge about the natural history of pediatric HCV infection, focuses on current management options, and provides a brief overview of future therapies.