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Why is viral eradication so important in patients with HCV-related cirrhosis?
1Hospital de Santa Maria - Gastroenterology and Hepatology, Lisbon, Portugal.
Insights
Direct-acting antivirals (DAAs) offer a safe and effective cure for chronic hepatitis C (HCV) patients with cirrhosis. Prioritizing treatment for these individuals can halt disease progression and improve survival rates.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- Chronic hepatitis C (HCV) infection frequently leads to cirrhosis, increasing the risk of hepatocellular carcinoma and mortality.
- The incidence of cirrhosis-related complications is projected to rise in the coming years.
- Cirrhosis affects approximately one-third of chronic HCV patients.
Purpose of the Study:
- To evaluate the efficacy and impact of direct-acting antivirals (DAAs) in patients with chronic HCV and cirrhosis.
- To highlight the importance of prioritizing treatment for cirrhotic HCV patients.
- To assess the potential of DAAs in improving liver function and halting disease progression.
Main Methods:
- Review of current literature on DAA therapy for HCV patients with cirrhosis.
- Analysis of cure rates and impact on liver function in compensated and decompensated cirrhosis.
- Assessment of DAA efficacy in Child-Pugh class C patients.
Main Results:
- DAAs achieve cure rates exceeding 90% in compensated cirrhosis.
- All-oral DAA therapy shows significant benefits for decompensated cirrhosis patients, a previously underserved group.
- DAA therapy can improve liver function in approximately 50% of Child-Pugh class C patients.
Conclusions:
- DAA therapy is a safe and highly effective treatment for chronic HCV, even in patients with cirrhosis.
- Early treatment of cirrhotic HCV patients with DAAs is crucial for halting disease progression, improving survival, and reducing liver transplantation needs.
- DAAs represent a significant advancement in managing advanced liver disease caused by HCV.
Abstract:
Approximately one-third of patients infected with chronic HCV have cirrhosis, and this is likely to increase in the near future. The risk of complications, mainly the development of hepatocellular carcinoma, depends on the presence of cirrhosis, and a significant increase in the incidence of cirrhosis-related events, including mortality, is likely in the following years. All-oral therapy with direct-acting antivirals (DAAs) offers a safe and short treatment, with cure rates over 90% in compensated cirrhosis. Cirrhotic patients should be given high priority for treatment because viral clearance has a significant impact on the natural history of HCV infection, halting the progression of the disease and inducing the regression of fibrosis, as well as reducing the need for liver transplantation and improving survival. The benefit of DAAs is great in patients with decompensated cirrhosis, up until recently a population for whom no alternative therapy was available. The efficacy of all-oral therapy has been reported to improve liver function in about 50% of Child-Pugh class C patients. The regression of cirrhosis observed in more than half of patients achieving viral eradication on prior interferon-based regimens still has to be demonstrated in patients treated with DAAs, although there is reason to believe that this will happen. Advanced cirrhosis will eventually become the last boundary of antiviral therapy that will soon be conquered with new drugs currently pending approval.
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