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The Benefit of Direct-Acting Antiviral HCV Cure Therapies

  • Paul J. PockrosEmail author
Chapter
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Part of the Topics in Medicinal Chemistry book series (TMC, volume 32)

Abstract

Although more than 600,000 patients in the USA have now been cured of HCV, the clinical benefits of cure have been seen primarily in patients with more advanced liver disease. This has resulted in a reduced incidence of liver cancers and reduced liver-related mortality. Benefits of cure in patients without cirrhosis have not been seen yet in systemic review, but are likely to be seen in the future years. There remain unresolved issues regarding patients with advanced fibrosis or cirrhosis who are cured of their HCV. It is not clear if fibrosis reverses after cure in everyone, if so by how much, and for how long patients with cirrhosis need to be monitored after cure. We have shown that 62% had improved liver stiffness measured by transient elastography (TE) that was consistent with regression of at least one stage of fibrosis over 1 year. Fifteen patients with matched liver biopsies prior to SVR underwent a biopsy after SVR. However, the post-SVR liver biopsies of only 4 patients showed F1–F2, while 11 patients still showed F3–F4, indicating that TE improvements are overstated when compared to histologic staging and that patients with cirrhosis before DAA therapy need to be monitored for hepatocellular carcinoma after cure.

Keywords

Chronic hepatitis C Cirrhosis regression Hepatocellular carcinoma Morphometry Transient elastography 

Abbreviations

DAA

Direct-acting antiviral therapy

F3

Advanced fibrosis

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

kPa

Kilopascals

SVR

Sustained virologic response

TE

Vibration-controlled transient elastography

Notes

Compliance with Ethical Standards

Conflict of Interest Paul J. Pockros has received research grants from Gilead, AbbVie, BMS, Merck, Conatus and has received a honorarium for speaking and consulting to PJP from Gilead, AbbVie, Merck, Conatus. He is Intercept Board of Directors member at Conatus.

Ethical Approval

All procedures were performed in accordance with the ethical standards of the Scripps institutional research committee and with the 1964 Helsinki declaration and its comparable standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study which was approved by the Scripps Human Subject committee IRB.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology/HepatologyScripps Clinic La JollaUSA
  2. 2.The Scripps Research InstituteLa JollaUSA
  3. 3.The Scripps Translational Science InstituteLa JollaUSA

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