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Abstract Details
Hepatic benefits of HCV cure
J Hepatol. 2020 Aug 7;S0168-8278(20)30530-4. doi: 10.1016/j.jhep.2020.08.006.Online ahead of print.
Vincenza Calvaruso1, Antonio Craxì2
Author information
1GI & Liver Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo. Electronic address: vincenza.calvaruso@unipa.it.
2GI & Liver Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo.
Abstract
HCV clearance obtained by direct-acting antiviral agents (DAAs) is conceivably linked to an improved outcome at all stages of liver disease. Available data however suggest that the maximum measurable benefit is obtained by treating patients before they reach the stage of compensated advanced chronic liver disease (cACLD). Ideally, all subjects with chronic hepatitis C (CHC) should be treated before development of advanced fibrosis or cirrhosis, since even if sustained virologic response (SVR) reduces in the latter the risk of decompensation and to a lesser degree of hepatocellular carcinoma (HCC) and improves survival, further progression of liver disease and adverse outcomes including hepatic deaths cannot be entirely avoided. The hepatic venous pressure gradient (HVPG) correlates closely to the stage of liver disease. Measurements of HVPG in patients with severe fibrosis or cirrhosis treated with DAAs shows that those with the highest degree of portal hypertension have the lowest probability of a meaningful reduction of portal pressure after SVR, and maintain a significant risk of decompensation. Reduction in liver stiffness is commonly observed in patients with cACLD but its role in predicting prognosis is yet to be demonstrated. Along the same line, in patients with decompensated cirrhosis prevention of further decompensation and of HCC is only weakly associated to SVR. Overall, the main clinical predictors of a high risk of HCC in patients who obtain SVR on DAAs are all indexes strongly reflecting advanced fibrosis and impaired hepatic function. Long term follow up of large real-life cohorts of patients treated at all stages of liver disease, but mainly those with mild to moderate fibrosis, will be needed to confirm the impact of SVR among diverse HCV infected populations and even more to better stratify the patients with higher risk of complications in order to define their correct surveillance.