title: Is the benefit of treating patients with cirrhosis proven?
abstract: Hepatitis C virus (HCV)-related cirrhosis is an extremely heterogeneous pathological condition with a wide spectrum of clinical manifestations, ranging from pre-clinical to compensated and decompensated stages, each of which is characterized by a different clinical outcome. To measure the benefit of a sustained virological response (SVR) with interferon (IFN)-based therapy, several studies have been performed in patients with compensated disease, while only a few have been performed in decompensated disease. Nevertheless, these studies have certain methodological weaknesses that may limit the accuracy of results. Access to new, more effective and safe direct acting antivirals (DAAs) has significantly changed these outcomes, with SVR rates that were not seen previously, making antiviral treatment available to patients with end-stage liver disease. However, the clinical benefit of treating patients with late stage disease is still poorly understood and must be investigated. The existence of a point of no return beyond which a SVR is not beneficial has not yet been determined. All of these issues are discussed in this review.
authors.affiliation: Department of Internal Medicine, Humanitas University Medicine, Rozzano, Italy.|Department of Internal Medicine, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Bruno
authors.affiliation: Department of Internal Medicine, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Boccaccio
authors.affiliation: Department of Internal Medicine, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Russo
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D058625:End Stage Liver Disease / Q000188:drug therapy; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000821:virology*; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin
keywords: cirrhosis; clinical outcome; direct acting antivirals; hepatitis C virus; interferon; natural history; sustained virological response