title: Management of HCV-Associated Liver Cirrhosis.
abstract: BACKGROUND
  Treatment of chronic hepatitis C infection is most urgent in patients with severe liver fibrosis and cirrhosis because of the high risk of decompensation, hepatocellular carcinoma, and consecutively death. The development and approval of several direct-acting antiviral drugs (DAA) in the past years has revolutionized antiviral therapy especially for patients with liver cirrhosis.
  
  
  METHODS
  This review will focus on recent data from clinical trials and recommendations for the therapy of hepatitis C-infected patients with compensated cirrhosis.
  
  
  RESULTS
  Clinical data for cirrhotic patients mainly exist for a combination of the nucleotide analog sofosbuvir with either a protease inhibitor (simeprevir) or an NS5A inhibitor (daclatasvir, ledipasvir) or a three-DAA combination consisting of an NS3 protease inhibitor, an NS5A inhibitor, and a non-nucleoside NS5B inhibitor (paritaprevir/ritonavir, ombitasvir, and dasabuvir). Rates of sustained virologic response in patients with compensated cirrhosis are comparable to patients without cirrhosis; however, the addition of ribavirin and/or longer treatment durations are especially recommended when other negative predictors are present, such as prior treatment failure, features of advanced cirrhosis, or the presence of baseline resistance.
  
  
  CONCLUSIONS
  Nowadays, a highly active, short, and safe interferon-free treatment regimen is available for almost all patients.
authors.affiliation: Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt/M., Germany.
authors.forename: Maximilian D
authors.initials: MD
authors.lastname: Schneider
authors.affiliation: Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt/M., Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
keywords: Direct-acting antiviral agents; Hepatitis C virus; Hepatocellular carcinoma; Liver cirrhosis; Sofosbuvir