Current Hepatology Reports

, Volume 15, Issue 1, pp 60–66 | Cite as

How to Treat Patients with Chronic Hepatitis C Virus Infection and Decompensated Cirrhosis

Hepatitis C (BR Bacon and KR Reddy, Section Editors)
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Part of the following topical collections:
  1. Topical Collection on Hepatitis C

Abstract

Patients with chronic hepatitis C virus infection (HCV) and decompensated liver disease are not uncommon and present a considerable therapeutic challenge. Interferon-alfa-based regimens, standard therapy for HCV until recently, are plagued by worse tolerability and efficacy in patients with decompensated disease than others. Recent data have emerged with direct-acting anti-viral agents (DAAs) that are currently available including sofosbuvir, ledipasvir, and ribavirin; sofosbuvir, daclatasvir +/− ribavirin; and sofosbuvir, simeprevir +/− ribavirin that reveal excellent tolerability and efficacy in this patient population. In fact, sofosbuvir, ledipasvir, and ribavirin demonstrated sustained virologic response (SVR) rates of 87 and 89 % in CTP B and C patients, respectively, with a 12-week course. The current HCV guidance document from the AASLD/IDSA addresses treatment regimen recommendations for patients with decompensated disease. Ongoing long-term studies that assess quality of life, effect on the complications of ESLD, the rates of de-listing for liver transplantation, rates of development of hepatocellular carcinoma, and mortality after SVR in patients with decompensated disease will help address the question of who to treat when. Data should be forthcoming, including data on emerging therapies. The decision to treat patients with decompensated disease may be difficult, and such patients present complex clinical issues that dictate that experienced personnel administer therapy if at all possible.

Keywords

Chronic HCV Decompensated liver disease Decompensated cirrhosis Liver transplantation Sofosbuvir Ledipasvir Daclatasvir 
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Notes

Compliance with Ethical Standards

Conflict of Interest

Steven L. Flamm reports grants and personal fees from Gilead, Abbvie, BMS, and Merck.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Northwestern Feinberg School of MedicineChicagoUSA

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