title: Treatment of chronic hepatitis C in patients with cirrhosis.
abstract: OBJECTIVE
  This article reviews treatment options of the approved and soon-to-be approved direct-acting antivirals (DAA)-based therapies in individuals with hepatitis C virus (HCV) cirrhosis.
  
  
  RESULTS
  DAA-based therapies have been shown to be well tolerated and effective in achieving viral cure in individuals with compensated and decompensated cirrhosis. Preliminary studies suggest that viral eradication arrests fibrosis progression and could lead to fibrosis regression. Long-term benefits of successful HCV treatment in this population translate into less frequent hepatic decompensation and hepatocellular carcinoma development, improvements in liver disease severity, reduction of liver-related mortality, and potential obviation of the need for transplantation. The optimization of viral eradication rates requires longer duration therapy and/or more complex combinations of drugs, including ribavirin. Treatment decisions are guided by HCV genotype, renal function, drug-drug interactions, and the severity of cirrhosis. Safety concerns are paramount in individuals with advanced liver disease and continued vigilance for hepatotoxicity and other complications is warranted, especially in those with decompensated cirrhosis.
  
  
  CONCLUSIONS
  The availability of high potency DAA-based therapies with excellent safety profiles has transformed the HCV-infected cirrhotic population into a group that is no longer 'difficult-to-treat'. Understanding the pretreatment factors that predict clinical benefits vs. harm remains key in treating this population.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Tianyan
authors.initials: T
authors.lastname: Chen
authors.forename: Norah
authors.initials: N
authors.lastname: Terrault
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D051436:Renal Insufficiency, Chronic / Q000150:complications
chemical_list: D000998:Antiviral Agents