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Management of HCV-Associated Liver Cirrhosis
#MMPMID27413726
Schneider MD
; Sarrazin C
Visc Med
2016[Apr]; 32
(2
): 96-104
PMID27413726
show ga
BACKGROUND: Treatment of chronic hepatitis C infection is most urgent in patients
with severe liver fibrosis and cirrhosis because of the high risk of
decompensation, hepatocellular carcinoma, and consecutively death. The
development and approval of several direct-acting antiviral drugs (DAA) in the
past years has revolutionized antiviral therapy especially for patients with
liver cirrhosis. METHODS: This review will focus on recent data from clinical
trials and recommendations for the therapy of hepatitis C-infected patients with
compensated cirrhosis. RESULTS: Clinical data for cirrhotic patients mainly exist
for a combination of the nucleotide analog sofosbuvir with either a protease
inhibitor (simeprevir) or an NS5A inhibitor (daclatasvir, ledipasvir) or a
three-DAA combination consisting of an NS3 protease inhibitor, an NS5A inhibitor,
and a non-nucleoside NS5B inhibitor (paritaprevir/ritonavir, ombitasvir, and
dasabuvir). Rates of sustained virologic response in patients with compensated
cirrhosis are comparable to patients without cirrhosis; however, the addition of
ribavirin and/or longer treatment durations are especially recommended when other
negative predictors are present, such as prior treatment failure, features of
advanced cirrhosis, or the presence of baseline resistance. CONCLUSION: Nowadays,
a highly active, short, and safe interferon-free treatment regimen is available
for almost all patients.
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