Management of HCV-related decompensated cirrhosis with direct-acting antiviral agents: who should be treated?
Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV genotype 4-related decompensated cirrhosis.
The study included a treatment group (n = 160) composed of HCV patients with decompensated cirrhosis who received DAAs for 3 months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for 24–31 months.
In treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores (p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs. the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%.
HCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD and survival. Clinical trial: (NCT03547895).
KeywordsHCV Decompensated cirrhosis DAAs Liver volume
Amr Shaaban Hanafy was responsible for the study concept and design and he is the Guarantor of the article. Mohamed Bassiony was responsible for data acquisition and recording, Mohammad Abd Alkhalik supervised radiological investigations. All authors had full access to all data in the study, and take responsibility for the integrity of the data and the accuracy of the analysis. Amr Hanafy wrote the manuscript and performed statistical analysis. All authors were responsible for the critical review and had approved the final draft submitted.
Compliance with ethical standards
Conflict of interest
Amr Shaaban Hanafy, Mohamed A. Bassiony and Mohammad Abd Alkhalik Basha declare that they have no conflict of interest.
The study was approved by Zagazig university institutional research committee at the 3rd of May 2015. Written, informed consent was obtained from each patient included in the study. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution’s human research committee.
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