title: Strategies for treating chronic HCV infection in patients with cirrhosis: latest evidence and clinical outcomes.
abstract: The burden of chronic hepatitis C virus (HCV) infection is significant and growing. HCV is considered one of the leading causes of liver disease worldwide and the leading cause of liver transplantation globally. While those infected is estimated in the hundreds of millions, this is likely an underestimation because of the indolent nature of this disease when first contracted. Approximately 20% of patients with HCV infection will progress to advanced fibrosis and cirrhosis. Those that do are at risk of decompensated liver disease including GI bleeding, encephalopathy, severe lab abnormalities, and hepatocellular carcinoma. Those individuals with advanced fibrosis and cirrhosis have historically been difficult to treat. The backbone of previous HCV regimens was interferon (IFN). The outcomes for IFN based regimens were poor and resulted in increased adverse events among those with advanced fibrosis and cirrhosis. Now, in the era of new direct acting antiviral (DAA's) medications, there is hope for curing chronic HCV in everyone, including those with advanced fibrosis and cirrhosis. This article provides a review on the most up to date data on the use of DAA's in patients with advanced fibrosis and cirrhosis. We are at a point where HCV could be truly eradicated, but to do so will require ensuring there are effective and safe treatments for those with advanced fibrosis and cirrhosis.
authors.affiliation: Division of Gastroenterology, Duke University School of Medicine, and Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Julius M
authors.initials: JM
authors.lastname: Wilder
authors.affiliation: Division of Gastroenterology, Duke University Medical Center, Duke Clinical Research Institute, DUMC 3913, Durham, NC 27710, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
keywords: cirrhosis; decompensated cirrhosis; direct acting antivirals; hepatitis C; interferon-free regimen