Management of ACLD After HBV-Suppression and HCV-Cure

Abstract

Antiviral therapies for hepatitis B (HBV)- and hepatitis C virus (HCV)-infection are among the most important medical milestones of all time. Since a virological response is almost universal, HBV-suppression and HCV-eradication are excellent models for the study of liver disease regression after the suppression/removal of the primary etiological factor. Insights obtained in these groups of patients are of central importance for advancing the management of the steadily growing population of patients in whom the primary etiological factors has been suppressed/removed. This chapter summarizes the impact of HBV-suppression and HCV-eradication on the course of advanced chronic liver disease (ACLD). For HBV-suppression, the panel has conducted a systematic review and meta-analysis, which is summarized in this chapter; for HCV-eradication, an individual patient data-based meta-analysis on the evolution of portal hypertension (PH) and noninvasive tests (NIT) has been conducted, and preliminary results are provided. Moreover, noninvasive strategies for variceal screening and risk stratification after HBV-suppression and HCV-eradication as well as their implications for patient management are discussed.