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Hepatic decompensation during direct-acting antiviral therapy of chronic hepatitis C

  • Jay H. Hoofnagle
    Correspondence
    Corresponding author. Address: JHH, LDRB, DDDN, NIDDK, Room 655, 6707 Democracy Blvd, Bethesda, MD 20892, United States. Tel.: +1 301 496 1333.
    Affiliations
    Liver Diseases Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
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Published:January 18, 2016DOI:https://doi.org/10.1016/j.jhep.2016.01.007
      Direct-acting antiviral agents for chronic hepatitis C have initiated a revolution in the management and control of this important liver disease [
      AASLD/IDSA Guidance Panel. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing and treating adults infected with hepatitis C virus.
      ]. Regimens of 2 to 4 oral agents without interferon or ribavirin regularly produce response rates of 95% or greater, at least with genotype 1 hepatitis C virus (HCV) infection [
      • Afdhal N.
      • Zeuzem S.
      • Kwo P.
      • Chojkier M.
      • Gitlin N.
      • Puoti M.
      • et al.
      Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection.
      ,
      • Feld J.J.
      • Kowdley K.V.
      • Coakley E.
      • Sigal S.
      • Nelson D.R.
      • Crawford D.
      • et al.
      Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin.
      ,
      • Zeuzem S.
      • Jacobson I.M.
      • Baykal T.
      • Marinho R.T.
      • Poordad F.
      • Bourlière M.
      • et al.
      Retreatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin.
      ]. More recently, agents with pan-genotypic activity have yielded similar response rates in virtually all HCV genotypes [
      • Feld J.J.
      • Jacobson I.M.
      • Hèzode C.
      • Asselah T.
      • Ruane P.J.
      • Gruener N.
      • et al.
      Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection.
      ,
      • Foster G.R.
      • Afdhal N.
      • Roberts S.K.
      • Bräu N.
      • Gane E.J.
      • Pianko S.
      • et al.
      Sofosbuvir and velpatasvir for HCV genotype 2 and 3 infection.
      ,
      • Curry M.P.
      • O’Leary J.G.
      • Bzowej N.
      • Muir A.J.
      • Korenblat K.M.
      • Fenkel J.M.
      • et al.
      Sofosbuvir and velpatasvir for HCV in patients with decompensated cirrhosis.
      ]. The ease of administration, short duration of treatment, excellent tolerance and absence of severe side effects have made therapy of hepatitis C appropriate to all patients with chronic hepatitis C, regardless of disease severity and irrespective of complicating co-morbidities. Suggestions have been made that therapy extended to all patients with HCV infection might be a viable means of elimination of this disease.

      Abbreviations:

      HCV (hepatitis C virus), LASH (lactic acidosis, microvesicular steatosis and hepatic dysfunction)

      Keywords

      Linked Article

      • Lactic acidosis in patients with hepatitis C virus cirrhosis and combined ribavirin/sofosbuvir treatment
        Journal of HepatologyVol. 64Issue 4
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          Patients with decompensated liver disease associated with chronic hepatitis C virus (HCV) infection before and after liver transplantation have a poor prognosis, and antiviral therapy is recommended when feasible [1–7]. Sustained virologic response (SVR) rates to (pegylated) interferon-alfa (PegIFNα) based antiviral therapies are lower in those patient cohorts compared to patients with compensated liver disease before liver transplantation [8–10]. Moreover, severity of liver disease and comorbidities may account for contraindications to PegIFNα based antiviral therapy.
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