Treatment of HCV in individuals with decompensated cirrhosis

Abstract

Mini Review J Liver Res Disord Ther 2017, 3(4): 00059 hepatocellular carcinoma, and/or acute on chronic liver failure may develop and result in diminished quality of life and survival without liver transplantation. Effective antiviral therapy that results in sustained virological response (SVR) is the only strategy that positively alters the natural history of liver disease associated with HCV infection by reducing the frequency of hepatic decompensation, liver-related mortality, all-cause mortality, need for liver transplantation, and hepatocellular carcinoma [2]. Furthermore, SVR is also associated with improved quality of life and increased work productivity [3]. Licensure of new generation direct-acting antiviral agents (DAAs) revolutionized treatment of HCV infection, as these agents have very high virological efficacy, low frequency of severe adverse events (AEs), and overall high barrier to resistance. Hepatic decompensation is associated with markedly diminished survival and poor quality of life, thus liver transplantation remains the treatment of choice regardless of the etiology of liver disease. Nevertheless, the large imbalance between individuals in need for liver transplantation and supply of donor organs remains an important limitation. Antiviral therapy with interferon-based regimens was particularly challenging in this population as it resulted in severe toxicity and exceedingly poor SVR. In contrast, interferon-free regimens with DAAs have excellent tolerability and high virological efficacy in individuals with decompensated cirrhosis (Child-Turcotte-Pugh [CTP] classes B and C), thus these agents have resurged interest of experienced practitioners in treating HCV infection in this population. Prior to initiating antiviral therapy with DAAs in individuals with decompensated cirrhosis it is important to assess and determine potential candidacy for liver transplantation. Conceivable benefits and risks of treating HCV infection pre-versus post-liver transplantation should be discussed in detail and some important clinical points unique to this population that must be addressed include: