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Management of HCV in Cirrhosis—a Rapidly Evolving Landscape

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Abstract

Despite the rapid progress in treatment, chronic hepatitis C virus (HCV) infection remains a growing cause of liver-related mortality globally. Patients who have been infected for decades are now presenting with advanced liver disease with the complications of cirrhosis and liver cancer. Early attempts at treatment with peginterferon and ribavirin were limited by toxicity, long treatment duration, and limited efficacy. This was especially relevant for patients with cirrhosis, where exposure to peginterferon-based therapy was relatively ineffective and led to high rates of toxicity. However, the recent development of multiple novel direct-acting antivirals (DAAs) has revolutionized the treatment of HCV. The majority of patients can now be cured with short courses of extremely well-tolerated all-oral regimens. However, the real test of these regimens comes in patients with more advanced liver disease, both in terms of safety and efficacy. Patients with cirrhosis have the greatest need for therapy and have traditionally been the most difficult to cure. The new therapies are rapidly changing this paradigm. Accumulating data suggest that high cure rates are achievable in patients with compensated cirrhosis and may even be possible in patients with signs of liver failure. This review will focus on the treatment of HCV in patients with cirrhosis, with an emphasis on the challenges that remain and strategies to deal with this important population.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age‐specific antibody to HCV seroprevalence. Hepatology. 2013;57:1333–42.

    Article  PubMed  Google Scholar 

  2. Global Burden of Hepatitis C Working Group. Global burden of disease (GBD) for hepatitis C. J Clin Pharmacol. 2004;44:20–9.

    Article  Google Scholar 

  3. Lavanchy D. The global burden of hepatitis C. Liver Int. 2009;29 Suppl 1:74–81.

    Article  PubMed  Google Scholar 

  4. Fattovich G, Giustina G, Degos F, Tremolada F, Diodati G, Almasio P, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology. 1997;112:463–72.

    Article  CAS  PubMed  Google Scholar 

  5. Thein H-H, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology. 2008;48:418–31.

    Article  PubMed  Google Scholar 

  6. Kanwal F, Kramer JR, Ilyas J, Duan Z, El-Serag HB. HCV genotype 3 is associated with an increased risk of cirrhosis and hepatocellular cancer in a national sample of U.S. veterans with HCV. Hepatology. 2014;60:98–105.

    Article  CAS  PubMed  Google Scholar 

  7. Shahid M, Idrees M, Nasir B, Raja AJ, Raza SM, Amin I, et al. Correlation of biochemical markers and HCV RNA titers with fibrosis stages and grades in chronic HCV-3a patients. Eur J Gastroenterol Hepatol. 2014;26:788–94.

    Article  CAS  PubMed  Google Scholar 

  8. Kirk GD, Mehta SH, Astemborski J, Galai N, Washington J, Higgins Y, et al. HIV, age, and the severity of hepatitis C virus-related liver disease: a cohort study. Ann Intern Med. 2013;158:658–66.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Feld JJ, Liang TJ. Hepatitis C—identifying patients with progressive liver injury. Hepatology. 2006;43:S194–206.

    Article  CAS  PubMed  Google Scholar 

  10. Freeman AJ, Dore GJ, Law MG, Thorpe M, Von Overbeck J, Lloyd AR, et al. Estimating progression to cirrhosis in chronic hepatitis C virus infection. Hepatology. 2001;34:809–16.

    Article  CAS  PubMed  Google Scholar 

  11. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997;349:825–32.

    Article  CAS  PubMed  Google Scholar 

  12. Hui C-K, Belaye T, Montegrande K, Wright TL. A comparison in the progression of liver fibrosis in chronic hepatitis C between persistently normal and elevated transaminase. J Hepatol. 2003;38:511–7.

    Article  CAS  PubMed  Google Scholar 

  13. Chu C-J, Lee S-D. Hepatitis B virus/hepatitis C virus coinfection: epidemiology, clinical features, viral interactions and treatment. J Gastroenterol Hepatol. 2008;23:512–20.

    Article  PubMed  Google Scholar 

  14. Gonzalez F, Van den Eynde E, Perez-Hoyos S, Navarro J, Curran A, Burgos J, et al. Liver stiffness and aspartate aminotransferase levels predict the risk for liver fibrosis progression in hepatitis C virus/HIV-coinfected patients. HIV Med. 2014. doi:10.1111/hiv.12197.

    Google Scholar 

  15. Probst A, Dang T, Bochud M, Egger M, Negro F, Bochud P-Y. Role of hepatitis C virus genotype 3 in liver fibrosis progression—a systematic review and meta-analysis. J Viral Hepat. 2011;18:745–59.

    Article  CAS  PubMed  Google Scholar 

  16. Patin E, Kutalik Z, Guergnon J, Bibert S, Nalpas B, Jouanguy E, et al. Genome-wide association study identifies variants associated with progression of liver fibrosis from HCV infection. Gastroenterology. 2012;143:1244–52.e1–12.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Zarski J-P, Mc Hutchison J, Bronowicki J-P, Sturm N, Garcia-Kennedy R, Hodaj E, et al. Rate of natural disease progression in patients with chronic hepatitis C. J Hepatol. 2003;38:307–14.

    Article  PubMed  Google Scholar 

  18. Wedemeyer H, Dore GJ, Ward JW. Estimates on HCV disease burden worldwide—filling the gaps. J Viral Hepat. 2015;22 Suppl 1:1–5. This paper summarizes the global epidemiology of HCV and the burden of disease in 2015.

    Article  PubMed  Google Scholar 

  19. Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today’s treatment paradigm. J Viral Hepat. 2014;21 Suppl 1:34–59.

    Article  PubMed  Google Scholar 

  20. Rein DB, Wittenborn JS, Weinbaum CM, Sabin M, Smith BD, Lesesne SB. Forecasting the morbidity and mortality associated with prevalent cases of pre-cirrhotic chronic hepatitis C in the United States. Dig Liver Dis. 2011;43:66–72.

    Article  PubMed  Google Scholar 

  21. Poynard T, McHutchison J, Manns M, Trepo C, Lindsay K, Goodman Z, et al. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C. Gastroenterology. 2002;122:1303–13.

    Article  CAS  PubMed  Google Scholar 

  22. Veldt BJ, Saracco G, Boyer N, Cammà C, Bellobuono A, Hopf U, et al. Long term clinical outcome of chronic hepatitis C patients with sustained virological response to interferon monotherapy. Gut. 2004;53:1504–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Aleman S, Rahbin N, Weiland O, Davidsdottir L, Hedenstierna M, Rose N, et al. A risk for hepatocellular carcinoma persists long-term after sustained virologic response in patients with hepatitis C-associated liver cirrhosis. Clin Infect Dis Oxford Univ Press. 2013;57:230–6.

    Article  CAS  Google Scholar 

  24. van der Meer AJ, Veldt BJ, Feld JJ, Wedemeyer H, Dufour J-F, Lammert F, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308:2584–93.

    Article  PubMed  Google Scholar 

  25. Schvarcz R, Ando Y, Sönnerborg A, Weiland O. Combination treatment with interferon alfa-2b and ribavirin for chronic hepatitis C in patients who have failed to achieve sustained response to interferon alone: Swedish experience. J Hepatol. 1995;23 Suppl 2:17–21.

    CAS  PubMed  Google Scholar 

  26. Kakumu S, Yoshioka K, Wakita T, Ishikawa T, Takayanagi M, Higashi Y. A pilot study of ribavirin and interferon beta for the treatment of chronic hepatitis C. Gastroenterology. 1993;105:507–12.

    CAS  PubMed  Google Scholar 

  27. McHutchison JG, Lawitz EJ, Shiffman ML, Muir AJ, Galler GW, McCone J, et al. Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. N Engl J Med. 2009;361:580–93.

    Article  CAS  PubMed  Google Scholar 

  28. Heathcote EJ, Shiffman ML, Cooksley WG, Dusheiko GM, Lee SS, Balart L, et al. Peginterferon alfa-2a in patients with chronic hepatitis C and cirrhosis. N Engl J Med. 2000;343:1673–80.

    Article  CAS  PubMed  Google Scholar 

  29. Kim KH, Jang BK, Chung WJ, Hwang JS, Kweon YO, Tak WY, et al. Peginterferon alpha and ribavirin combination therapy in patients with hepatitis C virus-related liver cirrhosis. Korean J Hepatol. 2011;17:220–5.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Roffi L, Colloredo G, Pioltelli P, Bellati G, Pozzpi M, Parravicini P, et al. Pegylated interferon-alpha2b plus ribavirin: an efficacious and well-tolerated treatment regimen for patients with hepatitis C virus related histologically proven cirrhosis. Antivir Ther (Lond). 2008;13:663–73.

    CAS  Google Scholar 

  31. Yu M-L, Dai C-Y, Huang J-F, Hou N-J, Lee L-P, Hsieh M-Y, et al. A randomised study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C. Gut. 2007;56:553–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Everson GT, Trotter J, Forman L, Kugelmas M, Halprin A, Fey B, et al. Treatment of advanced hepatitis C with a low accelerating dosage regimen of antiviral therapy. Hepatology. 2005;42:255–62.

    Article  CAS  PubMed  Google Scholar 

  33. Jacobson IM, McHutchison JG, Dusheiko G, Di Bisceglie AM, Reddy KR, Bzowej NH, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;364:2405–16.

    Article  CAS  PubMed  Google Scholar 

  34. Lawitz E, Sulkowski MS, Ghalib R, Rodriguez-Torres M, Younossi ZM, Corregidor A, et al. Simeprevir plus sofosbuvir, with or without ribavirin, to treat chronic infection with hepatitis C virus genotype 1 in non-responders to pegylated interferon and ribavirin and treatment-naive patients: the COSMOS randomised study. Lancet. 2014;384:1756–65.

    Article  CAS  PubMed  Google Scholar 

  35. Bacon BR, Gordon SC, Lawitz E, Marcellin P, Vierling JM, Zeuzem S, et al. Boceprevir for previously treated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1207–17.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Hézode C, Fontaine H, Dorival C, Larrey D, Zoulim F, Canva V, et al. Triple therapy in treatment-experienced patients with HCV-cirrhosis in a multicentre cohort of the French Early Access Programme (ANRS CO20-CUPIC) - NCT01514890. J Hepatol. 2013;59:434–41. Real world data on the safety of boceprevir and telaprevir, showing high rates of adverse events, especially in cirrhotic patients.

    Article  PubMed  Google Scholar 

  37. Hézode C, Fontaine H, Dorival C, Zoulim F, Larrey D, Canva V, et al. Effectiveness of telaprevir or boceprevir in treatment-experienced patients with HCV genotype 1 infection and cirrhosis. Gastroenterology. 2014;147:132–4.

    Article  PubMed  Google Scholar 

  38. Flamm SL, Everson GT, M C. Ledipasvir/sofosbuvir with ribavirin for the treatment of HCV in patients with decompensated cirrhosis: preliminary results of a prospective, multicenter study. 65th Annual Meeting of the American Association for the Study of Liver Diseases, November 7–11, 2014, Boston, USA; abstract 239. This important abstract describes the efficacy and safety of sofosbuvir/ledipasvir in decompensated cirrhosis.

  39. Lok AS, Gardiner DF, Lawitz E, Martorell C, Everson GT, Ghalib R, et al. Preliminary study of two antiviral agents for hepatitis C genotype 1. N Engl J Med. 2012;366:216–24.

    Article  CAS  PubMed  Google Scholar 

  40. Kumada H, Suzuki Y, Ikeda K, Toyota J, Karino Y, Chayama K, et al. Daclatasvir plus asunaprevir for chronic HCV genotype 1b infection. Hepatology. 2014;59:2083–91.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Jacobson IM, Dore GJ, Foster GR, Fried MW, Radu M, Rafalsky VV, et al. Simeprevir with pegylated interferon alfa 2a plus ribavirin in treatment-naive patients with chronic hepatitis C virus genotype 1 infection (QUEST-1): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet. 2014;384:403–13.

    Article  CAS  PubMed  Google Scholar 

  42. Hézode C, Hirschfield GM, Ghesquiere W, Sievert W, Rodriguez-Torres M, Shafran SD, et al. Daclatasvir plus peginterferon alfa and ribavirin for treatment-naive chronic hepatitis C genotype 1 or 4 infection: a randomised study. Gut. BMJ Publishing Group Ltd and British Society of Gastroenterology. 2014; gutjnl–2014–307498.

  43. Reichard O, Andersson J, Schvarcz R, Weiland O. Ribavirin treatment for chronic hepatitis C. Lancet. 1991;337:1058–61.

    Article  CAS  PubMed  Google Scholar 

  44. McHutchison JG, Gordon SC, Schiff ER, Shiffman ML, Lee WM, Rustgi VK, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis Interventional Therapy Group. N Engl J Med. 1998;339:1485–92.

    Article  CAS  PubMed  Google Scholar 

  45. Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Gonçales FL, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002;347:975–82.

    Article  CAS  PubMed  Google Scholar 

  46. Yee BE, Nguyen NH, Zhang B, Vutien P, Wong CR, Lutchman GA, et al. Meta-analysis: influence of host and viral factors in patients with chronic hepatitis C genotype 4 treated with pegylated interferon and ribavirin. Eur J Gastroenterol Hepatol. 2014;26:1189–201.

    Article  CAS  PubMed  Google Scholar 

  47. Powis J, Peltekian KM, Lee SS, Sherman M, Bain VG, Cooper C, et al. Exploring differences in response to treatment with peginterferon alpha 2a (40 kD) and ribavirin in chronic hepatitis C between genotypes 2 and 3. J Viral Hepat. 2008;15:52–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  48. Bota S, Sporea I, Sirli R, Popescu A, Neghină AM, Dănilă M, et al. Severe adverse events during antiviral therapy in hepatitis C virus cirrhotic patients: a systematic review. World J Hepatol. 2013;5:120–6.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Zeuzem S, Andreone P, Pol S, Lawitz E, Diago M, Roberts S, et al. Telaprevir for retreatment of HCV infection. N Engl J Med. 2011;364:2417–28.

    Article  CAS  PubMed  Google Scholar 

  50. Poordad F, McCone J, Bacon BR, Bruno S, Manns MP, Sulkowski MS, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1195–206.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  51. Welsch C, Jesudian A, Zeuzem S, Jacobson I. New direct-acting antiviral agents for the treatment of hepatitis C virus infection and perspectives. Gut. 2012;61 Suppl 1:i36–46.

    Article  CAS  PubMed  Google Scholar 

  52. Schinazi R, Halfon P, Marcellin P, Asselah T. HCV direct-acting antiviral agents: the best interferon-free combinations. Liver Int. 2014;34 Suppl 1:69–78.

    Article  CAS  PubMed  Google Scholar 

  53. Manns M, Marcellin P, Poordad F, de Araujo ESA, Buti M, Horsmans Y, et al. Simeprevir with pegylated interferon alfa 2a or 2b plus ribavirin in treatment-naive patients with chronic hepatitis C virus genotype 1 infection (QUEST-2): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2014;384:414–26.

    Article  CAS  PubMed  Google Scholar 

  54. Mariño Z, van Bömmel F, Forns X, Berg T. New concepts of sofosbuvir-based treatment regimens in patients with hepatitis C. Gut. 2014;63:207–15.

    PubMed  Google Scholar 

  55. Feld JJ. Interferon-free strategies with a nucleoside/nucleotide analogue. Semin Liver Dis. 2014;34:37–46.

    Article  CAS  PubMed  Google Scholar 

  56. Lawitz E, Mangia A, Wyles D, Rodriguez-Torres M, Hassanein T, Gordon SC, et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med. 2013;368:1878–87.

    Article  CAS  PubMed  Google Scholar 

  57. Jensen DM, OLeary J, Pockros P, Sherman K. Safety and efficacy of sofosbuvir-containing regimens for hepatitis C: real-world experience in a diverse, longitudinal observational cohort. 65th Annual Meeting of the American Association for the Study of Liver Diseases, November 7–11, 2014, Boston, USA; abstract 45. This abstract describes the real-world safety and efficacy of sofosbuvir-containing regimens, showing that treatment efficacy and safety is similar to results from large RCTs.

  58. Capraru C, Kuczynski M, La D, Kaznowski D. Efficacy and safety of sofosbuvir plus simeprevir in patients with advanced HCV cirrhosis. 65th Annual Meeting of the American Association for the Study of Liver Diseases, November 7–11, 2014, Boston, USA; abstract 963

  59. Svarovskaia ES, Dvory-Sobol H, Parkin N, Hebner C, Gontcharova V, Martin R, et al. Infrequent development of resistance in genotype 1–6 hepatitis C virus-infected subjects treated with sofosbuvir in phase 2 and 3 clinical trials. Clin Infect Dis. 2014;59:1666–74.

    Article  PubMed  Google Scholar 

  60. Gao M. Antiviral activity and resistance of HCV NS5A replication complex inhibitors. Curr Opin Virol. 2013;3:514–20.

    Article  CAS  PubMed  Google Scholar 

  61. Afdhal N, Zeuzem S, Kwo P, Chojkier M, Gitlin N, Puoti M, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med. 2014;370:1889–98.

    Article  PubMed  Google Scholar 

  62. Afdhal N, Reddy KR, Nelson DR, Lawitz E, Gordon SC, Schiff E, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med. 2014;370:1483–93.

    Article  CAS  PubMed  Google Scholar 

  63. FDA 2014 - Label for Harvoni (Sofosbuvir/Ledipasvir) [Internet]. [cited 2015 Jan 26]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/205834s000lbl.pdf

  64. Bourlière M, Bronowicki J-P, de Ledinghen V, Hézode C, Zoulim F, Mathurin P. Ledipasvir/sofosbuvir fixed-dose combination is safe and efficacious in cirrhotic patients who have previously failed protease-inhibitor based triple therapy. 65th Annual Meeting of the American Association for the Study of Liver Diseases, November 7–11, 2014, Boston, USA; abstract LB-6

  65. Bourlière M, Sulkowski M, Omata M. An integrated safety and efficacy analysis of >500 patients with compensated cirrhosis treated with ledipasvir/sofosbuvir with or without ribavirin. 65th Annual Meeting of the American Association for the Study of Liver Diseases, November 7–11, 2014, Boston, USA; abstract 82

  66. Sulkowski MS, Gardiner DF, Rodriguez-Torres M, Reddy KR, Hassanein T, Jacobson I, et al. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med. 2014;370:211–21.

    Article  CAS  PubMed  Google Scholar 

  67. Poordad F, Hézode C, Trinh R, Kowdley KV, Zeuzem S, Agarwal K, et al. ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. N Engl J Med. 2014;370:1973–82.

    Article  PubMed  Google Scholar 

  68. Sulkowski M, Mallolas J, Pol S, Bourliere M, Gerstoft J, Shibolet O, et al. O63 efficacy and safety of the all-oral regimen, Mk-5172/Mk-8742 +/− Rbv for 12 weeks In Gt1 HCV/HIV co-infected patients: The C-WORTHY Study. J Hepatol. 2014;60:S26.

    Article  Google Scholar 

  69. Lawitz E. C-SWIFT: Grazoprevir (MK-5172) + elbasvir (MK-8742) + sofosbuvir in treatment-naive patients with hepatitis C virus genotype 1 infection, with and without cirrhosis, for durations of 4, 6, or 8 weeks. 65th Annual Meeting of the American Association for the Study of Liver Diseases, November 7–11, 2014, Boston, USA; abstract LB-33.

  70. Reddy KR, Everson G, Flamm SL. Ledipasvir/sofosbuvir with ribavirin for the treatment of HCV in patients with post transplant recurrence: preliminary results of a prospective, multicenter study. 65th Annual Meeting of the American Association for the Study of Liver Diseases, November 7–11, 2014, Boston, USA; abstract 8.

  71. Jacobson IM, Gordon SC, Kowdley KV, Yoshida EM, Rodriguez-Torres M, Sulkowski MS, et al. Sofosbuvir for hepatitis C genotype 2 or 3 in patients without treatment options. N Engl J Med. 2013;368:1867–77.

    Article  CAS  PubMed  Google Scholar 

  72. Zeuzem S, Dusheiko GM, Salupere R, Mangia A, Flisiak R, Hyland RH, et al. Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med. 2014;370:1993–2001.

    Article  PubMed  Google Scholar 

  73. Lawitz E, Poordad F, Brainard DM, Hyland RH, An D, Dvory-Sobol H, et al. Sofosbuvir with peginterferon-ribavirin for 12 weeks in previously treated patients with hepatitis C genotype 2 or 3 and cirrhosis. Hepatology. 2014. doi:10.1002/hep.27567.

    Google Scholar 

  74. Esteban R, Nyberg L, Lalezari J, Ni L, Doehle B, Kanwar B, et al. Successful retreatment with sofosbuvir-containing regimens for HCV genotype 2 or 3 infected patients who failed prior sofosbuvir plus ribavirin therapy. J Hepatol Elsevier. 2015;60:S4–5.

    Article  Google Scholar 

  75. Nelson DR, Cooper JN, Lalezari JP, Lawitz E, Pockros PJ, Gitlin N, et al. All-oral 12-week treatment with daclatasvir plus sofosbuvir in patients with hepatitis C virus genotype 3 infection: ALLY-3 phase 3 study. 65th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). November 7–11, 2014; Boston, MA; abstract LB-3.

  76. Link JO, Taylor JG, Xu L, Mitchell M, Guo H, Liu H, et al. Discovery of ledipasvir (GS-5885): a potent, once-daily oral NS5A inhibitor for the treatment of hepatitis C virus infection. J Med Chem. 2014;57:2033–46.

    Article  CAS  PubMed  Google Scholar 

  77. Gane EJ, Hyland RH, An D, Pang PS, Symonds WT, McHutchison JG, et al. Sofosbuvir/ledipasvir fixed dose combination is safe and effective in difficult-to-treat populations including genotype-3 patients, decompensated genotype-1 patients, and genotype-1 patients with prior sofosbuvir treatment experience. J Hepatol. 2014;60:S3–4.

    Article  Google Scholar 

  78. Gane EJ, Stedman CA, Hyland RH, Ding X, Svarovskaia E, Symonds WT, et al. Nucleotide polymerase inhibitor sofosbuvir plus ribavirin for hepatitis C. N Engl J Med. 2013;368:34–44.

    Article  CAS  PubMed  Google Scholar 

  79. Pianko S, Flamm SL, Shiffman ML. High Efficacy of Treatment with Sofosbuvir + GS-5816 ± Ribavirin for 12 Weeks in Treatment Experienced Patients with Genotype 1 or 3 HCV Infection. 65th Annual Meeting of the American Association for the Study of Liver Diseases, November 7–11, 2014, Boston, USA; abstract 80.

  80. Ruane PJ, Ain D, Stryker R, Meshrekey R, Soliman M, Wolfe PR, et al. Sofosbuvir plus ribavirin for the treatment of chronic genotype 4 hepatitis C virus infection in patients of Egyptian ancestry. J Hepatol. 2014. doi:10.1016/j.jhep.2014.10.044.

    PubMed  Google Scholar 

  81. Pol S, Reddy RK, Baykal T. Interferon-free regimens of ombitasvir and ABT-450/r with or without ribavirin in patients with HCV genotype 4 infection. 65th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). November 7–11, 2014; Boston, MA; abstract 1928.

  82. Kapoor R, Kohli A, Sidharthan S. All oral treatment for genotype 4 chronic hepatitis C infection with sofosbuvir and ledipasvir: interim results from the NIAID SYNERGY trial. 65th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). November 7–11, 2014; Boston, MA; abstract 240.

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Conflict of Interest

Suraj A. Sharma reports grants from Gilead Sciences/CASL, outside the submitted work.

Jordan J. Feld reports grants and personal fees from AbbVie, personal fees from Bristol-Myers Squibb (BMS), grants and personal fees from Gilead Sciences, grants and personal fees from Janssen, grants and personal fees from Merck, personal fees from Theravance, grants from Boehringer Ingelheim, and grants from Santaris, outside the submitted work.

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  1. Toronto Center for Liver Disease, Sandra Rotman Centre for Global Health, University Health Network, University of Toronto, 6B-Fell Pavilion, Room 158, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada

    Suraj A. Sharma & Jordan J. Feld

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Correspondence to Jordan J. Feld.

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Sharma, S.A., Feld, J.J. Management of HCV in Cirrhosis—a Rapidly Evolving Landscape. Curr Gastroenterol Rep 17, 20 (2015). https://doi.org/10.1007/s11894-015-0443-3

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