Management of patients with pre-therapeutic advanced liver fibrosis following HCV eradication

Abstract

Patients with HCV-related bridging fibrosis or cirrhosis remain at risk of developing lifethreatening complications even after achieving a sustained virological response. Although it is reduced, the risk of liver-related events in these patients justifies their inclusion in surveillance programmes dedicated to the early detection of hepatocellular carcinoma and the screening for portal hypertension. Biochemical parameters or non-invasive tests might indicate the potential progression of liver injury despite viral clearance. Specific attention must be focused on the management of comorbidities, while dedicated educational programmes must be encouraged to increase compliance and commitment to surveillance. Better knowledge of the long-term evolution of these patients, who now live longer, is essential to improve risk stratification and refine screening strategies in this growing population.

Stratification of Hepatocellular Carcinoma Risk Following HCV Eradication or HBV Control

“…However, HCC may occur in patients with bridging fibrosis (METAVIR score F3) [ 15 ]. Whether based on studies conducted in the interferon treatment era or in the DAA treatment era, the absolute reduction in HCC risk is now well documented, but primary liver cancer still occurs over the long term at a rate that probably does not exceed 3% per year [ 16 ]. If all international guidelines endorse lifelong HCC surveillance following SVR in patients with cirrhosis [ 4 , 17 , 18 ], the case of patients with bridging fibrosis is debated with dedicated analyses suggesting a lack of cost-effectiveness in this population [ 10 ].…”

Epidemiological projections of viral‐induced hepatocellular carcinoma in the perspective of WHO global hepatitis elimination

“…For these reasons, a pragmatic suggestion is to keep all F3 patient in HCC surveillance programs. 66…”

“…Moreover, the difference in terms of non‐invasive measurement of liver fibrosis between advanced fibrosis and cirrhosis is very small, and failing to recognize the transition between two stages may lead to the exclusion of some patients who would benefit from the surveillance programs if the HCC surveillance is only indicated for those who have cirrhosis. For these reasons, a pragmatic suggestion is to keep all F3 patient in HCC surveillance programs 66 …”

Nachbetreuung von PatientInnen mit „sustained virologic response“

“…Aus Kohorten, welche mittels interferonbasierten Therapien behandelt wurden, sowie aus rezenten Studien ist bekannt, dass neben dem Risiko, eine hepatische Dekompensation zu erleiden, auch das Risiko des Auftretens eines HCC durch eine erfolgreiche HCV-Therapie deutlich reduziert wird [31][32][33][34][35]. Initiale Befürchtungen, dass das Risiko eines De-novo-oder rekurrierenden HCC kurz nach DAA-Therapie erhöht wäre [36,37], wurden in Folgeuntersuchungen nicht bestätigt [38]. Abb.…”