The Benefit of Direct-Acting Antiviral HCV Cure Therapies

Abstract

Although more than 600,000 patients in the USA have now been cured of HCV, the clinical benefits of cure have been seen primarily in patients with more advanced liver disease. This has resulted in a reduced incidence of liver cancers and reduced liver-related mortality. Benefits of cure in patients without cirrhosis have not been seen yet in systemic review, but are likely to be seen in the future years. There remain unresolved issues regarding patients with advanced fibrosis or cirrhosis who are cured of their HCV. It is not clear if fibrosis reverses after cure in everyone, if so by how much, and for how long patients with cirrhosis need to be monitored after cure. We have shown that 62% had improved liver stiffness measured by transient elastography (TE) that was consistent with regression of at least one stage of fibrosis over 1 year. Fifteen patients with matched liver biopsies prior to SVR underwent a biopsy after SVR. However, the post-SVR liver biopsies of only 4 patients showed F1–F2, while 11 patients still showed F3–F4, indicating that TE improvements are overstated when compared to histologic staging and that patients with cirrhosis before DAA therapy need to be monitored for hepatocellular carcinoma after cure.