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Treatment of chronic hepatitis C in patients with decompensated cirrhosis

Gregory T Everson1

  • 1University of Colorado School of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA.

Reviews in Gastroenterological Disorders
|June 9, 2004
PubMed

Insights

Antiviral therapy for chronic hepatitis C (HCV) shows variable success in achieving sustained virologic response (SVR). For advanced liver disease, especially decompensated cirrhosis, treatment may focus on viral clearance to improve transplant outcomes and slow progression.

Area of Science:

  • Hepatology
  • Virology
  • Transplantation Medicine

Background:

  • Chronic hepatitis C virus (HCV) infection is a primary driver for liver transplantation in the US.
  • Treatment efficacy for sustained virologic response (SVR) varies significantly with HCV genotype and liver disease severity.
  • Declining response rates are observed with advanced liver disease and prior treatment failures.

Purpose of the Study:

  • To evaluate the effectiveness of antiviral therapy in patients with chronic hepatitis C and advanced liver disease.
  • To assess the impact of HCV viral clearance on liver transplantation outcomes.
  • To explore strategies for managing HCV in patients with decompensated cirrhosis.

Main Methods:

  • Analysis of existing clinical trial data on antiviral therapy for chronic hepatitis C.
  • Review of SVR rates across different HCV genotypes and stages of liver fibrosis/cirrhosis.
  • Examination of on-treatment viral clearance rates in patients with decompensated cirrhosis.
  • Assessment of pretransplantation HCV RNA clearance and its effect on post-transplant recurrence.

Main Results:

  • SVR rates range from 41% for genotype 1 to 73% for genotypes 2/3 in patients with advanced fibrosis or early compensated cirrhosis.
  • Therapeutic response diminishes with increasing liver disease severity and in those with prior interferon treatment failure.
  • On-treatment HCV RNA clearance is observed in approximately 30% (genotype 1) and 80% (genotypes 2/3) of patients with decompensated cirrhosis.
  • Pretransplantation HCV RNA clearance may reduce post-transplant HCV recurrence.

Conclusions:

  • Antiviral therapy offers potential benefits in chronic hepatitis C, but SVR rates are limited in advanced disease.
  • Achieving viral clearance, even without SVR, may be crucial for improving outcomes in liver transplant candidates.
  • Maintenance therapy with peginterferon might mitigate disease progression and decompensation in non-responders.

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