Antiviral therapy in patients with HCV-cirrhosis
Journal Title: Annals of Hepatology - Year 2009, Vol 8, Issue 4
Abstract
The main cause of liver cirrhosis and liver cancer in the western world is Hepatitis C virus (HCV) infection. Liver transplantation is the only effective treatment once the disease is decompensated. In viremic patients who undergo transplantation, disease recurrence is universal resulting in the development of a new cirrhosis in about one third of the patients after 5 to 10 years of follow-up. Initiation of the antiviral treatment with Peg-IFN and ribavirin prior to transplantation may prevent HCV recurrence if a sustained viral response (SVR) is achieved. Moreover, it might even be possible to achieve an improvement of the liver function degree so that transplantation may be differed. There are few studies that assess the efficacy and safety of the antiviral treatment in the cirrhotic setting. Available information shows SVR rates between 20 and 40%, lower with decompensated disease. The need for treatment withdrawal and dose reductions is significant in this setting. Cytopenias are one of the most frequent adverse effects; hematopoietic growth factors have shown to increase patient compliance, but it is still unclear whether they result in greater SVR. In addition, an increased risk of bacterial infections has been recently described, with a recommendation to use prophylactic therapy during antiviral treatment. In conclusion, antiviral therapy is an option for cirrhotic patients who have a good liver function but should not be recommended in patients with Child-Pugh-Turcotte class C, due to a high risk of severe complications.
Authors and Affiliations
Josep Melero, Marina Berenguer
Keywords
Related Articles
- EP ID EP77883
- DOI -
- Views 130
- Downloads 0
Oral Acetyl-L-Carnitine treatment in hepatic encephalopathy: view of evidence-based medicine
Objective. To systematically review the effect of Acetyl-L-Carnitine in patients with hepatic encephalopathy.Material and methods. Design: systematic review and meta-analysis. Data sources: The Cochrane Library, MEDLINE,...
Combined hepatocellular-cholangiocarcinoma (cHCC-CC): a distinct entity
Patients with hepatocellular carcinoma (HCC), the fifth most common cancer worldwide, display a highly variable clinical course, suggesting that HCC encompasses several biologically distinct subtypes. This heterogeneity...
Serum homocysteine levels in patients with nonalcoholic fatty liver disease
Background and rational for the study. Nonalcoholic fatty liver disease (NAFLD) is regarded as the hepatic component of insulin resistance (IR) syndrome, but data on serum homocysteine (HCY) are limited. The aim of the s...
Metastatic lymphoepithelioma-like hepatocellular carcinoma: a potential diagnostic pitfall and demonstration of PD-L1 expression
Liver stiffness measurements increase after meal ingestion – an important step towards standardization