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Management of HCV-related decompensated cirrhosis with direct-acting antiviral agents: who should be treated?

Amr Shaaban Hanafy1,2, Mohamed A Bassiony3, Mohammad Abd Alkhalik Basha4

  • 1Internal Medicine Department, Hepatology Division, Zagazig University, Sharkia, Zagazig, 44519, Egypt. Dr_amr_hanafy@yahoo.com.

Hepatology International
|February 14, 2019
PubMed

Insights

Direct-acting antiviral drugs (DAAs) significantly improved outcomes for patients with hepatitis C virus (HCV) decompensated cirrhosis. Treatment led to better liver function, reduced complications, and increased survival rates in this challenging patient group.

Area of Science:

  • Hepatology
  • Virology
  • Clinical Medicine

Background:

  • Decompensated cirrhosis due to hepatitis C virus (HCV) presents ongoing treatment challenges, even with direct-acting antiviral drugs (DAAs).
  • HCV genotype 4-related decompensated cirrhosis requires effective management strategies.
  • Clinical Trial NCT03547895 evaluated DAA efficacy in this population.

Purpose of the Study:

  • To assess the efficacy and safety of direct-acting antiviral drugs (DAAs) in managing hepatitis C virus (HCV) genotype 4-related decompensated cirrhosis.
  • To evaluate the impact of DAAs on liver function, complications, and survival.
  • To identify predictors of complications and survival post-DAA therapy.

Main Methods:

  • A treatment group (n=160) received 3 months of DAAs for HCV decompensated cirrhosis.
  • A matched control group (n=80) did not receive DAAs.
  • Follow-up extended for 24-31 months, with assessments including liver volume via ultrasound.

Main Results:

  • The DAA treatment group showed significant improvements in platelet count, albumin, Child-Turcotte-Pugh (CTP), and Model for End-Stage Liver Disease (MELD) scores.
  • A notable reduction in hepatic encephalopathy (HE) frequency was observed, with 90% achieving sustained virologic response (SVR).
  • Hepatocellular carcinoma (HCC) developed in 10% of treated patients; however, survival was significantly higher (28.9 months) compared to the control group (11.4 months). Liver volume < 495 ml predicted complications like HCC and reduced survival.

Conclusions:

  • DAAs are effective in achieving high SVR rates (90%) in HCV patients with decompensated cirrhosis and adequate liver volume.
  • DAA therapy improves CTP and MELD scores, reduces HE, and enhances survival.
  • Adequate liver volume is crucial for favorable outcomes, and ultrasound measurement can predict complications and survival post-treatment.
Abstract

Keywords:
DAAsDecompensated cirrhosisHCVLiver volume

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