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Beyond cure: preventing and managing the complications of end-stage liver disease
Marina Berenguer1, María García-Eliz, Chiara Baiguera
1aLiver Unit, Ciberehd and University of Valencia, Valencia, Spain bDivision of Infectious Diseases AO Ospedale Niguarda Ca' Granda, Milano, Italy.
Insights
Hepatitis C virus (HCV) eradication in cirrhosis patients leads to favorable outcomes, including liver health improvements and extrahepatic benefits. Continued monitoring after sustained virologic response (SVR) is crucial for managing potential complications and liver dysfunction.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- Cirrhosis poses significant health risks.
- Hepatitis C virus (HCV) infection is a leading cause of cirrhosis.
- Effective antiviral therapies offer potential for HCV eradication.
Purpose of the Study:
- To define the implications of HCV eradication in patients with cirrhosis.
- To assess the impact of sustained virologic response (SVR) on patient outcomes.
- To identify critical factors in managing patients post-HCV eradication.
Main Methods:
- Literature review of studies on HCV eradication in cirrhotic patients.
- Analysis of outcomes associated with sustained virologic response (SVR).
- Evaluation of extrahepatic benefits and long-term follow-up strategies.
Main Results:
- SVR is linked to favorable outcomes, including cirrhosis regression.
- Extrahepatic benefits include improved quality of life and reduced risk of diabetes and cardiovascular diseases.
- Identifying the 'point of no return' for clinical improvement post-eradication is critical in decompensated cirrhosis.
Conclusions:
- HCV eradication can lead to cirrhosis regression or stabilization.
- Post-eradication follow-up is essential for early detection of HCC and liver dysfunction.
- HCV eradication offers significant extrahepatic advantages beyond liver health.
Purpose Of Review:
The aim of this review was to define the implication of hepatitis C virus (HCV) eradication in patients with cirrhosis.
Recent Findings:
Sustained virologic response (SVR) is associated with a favourable outcome in patients with cirrhosis especially in the presence of regression of cirrhosis but also with extrahepatic outcomes regarding health-related quality of life, risk of diabetes, risk of cardiovascular diseases and control of HIV replication by antiretroviral therapy. In patients with decompensated cirrhosis identifying the point of no return where viral eradication is not followed by clinical improvement is extremely relevant. A strict follow-up is needed in order to early diagnose HCC and signs of liver dysfunction, even after SVR, not only in patients with histological diagnosis of cirrhosis but also in those with advanced disease identified by liver stiffness measurements or by noninvasive methods.
Summary:
Eradication of HCV is associated with regression or 'freezing' of cirrhosis even if it is still unknown the point of no return where this has no benefit for the patient. Nevertheless, in patients with cirrhosis, follow-up should be pursued after eradication of HCV. In addition, HCV eradication has several extrahepatic benefits.
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