The benefits of hepatitis C virus cure: Every rose has thorns

Abstract

To examine mid-term benefits on hepatic complications, extrahepatic clinical syndromes and quality of life associated with HCV cure; to review the few safety issues linked to oral direct-acting antivirals (DAAs); and to discuss the potential population benefits of reducing the burden of HCV infection. DAAs cure HCV infection in more than 95% of patients. The halting of liver inflammation and fibrosis progression translates into both hepatic and extrahepatic benefits and reduces the need for liver transplantation. A reduction in the frequency of extrahepatic manifestations such as mixed cryoglobulinaemia and vasculitis and improvements in quality of life and fatigue have also been described. A few safety issues linked to DAAs such as the potential recurrence of aggressive HCC, the flares of hepatitis B virus in patients with overt or occult HBV infection are been discussed. Curing HCV infection also has a high potential to reduce the burden of HCV infection at the population level. With widespread scaling up of HCV treatment, several modeling studies suggest that major reductions in HCV prevalence and incidence are possible, and that elimination of viral hepatitis is an achievable target by 2030.

Impact of Direct Acting Antiviral Agents on Psychiatric and Sexual Health of Patients with Hepatitis C Virus

“…In a retrospective cohort study, it was found that Beck Depression Inventory scores improved with sofosbuvir-based treatment (29). DAAs are supposed to reduce extrahepatic manifestations such as fatigue and depression by reducing the systemic inflammation and immune activation secondary to HCV replication (30). However, in our study, we did not observe an improvement in depression or anxiety scores.…”

Increasing mortality associated with the more recent epidemic wave of hepatitis C virus infection in Northern Italy

“…10 Early treatment of infected individuals is needed to reduce the risk of hepatocellular carcinoma occurrence. 9 The results of the present study show that liver cancer currently represents the main cause of death among decedents with any mention of HCV infection.…”

“…In Italy, treatment with DAA was initially restricted to patients with advanced liver disease, and thereafter, the indication for treatment moved to the less severe stages . Early treatment of infected individuals is needed to reduce the risk of hepatocellular carcinoma occurrence . The results of the present study show that liver cancer currently represents the main cause of death among decedents with any mention of HCV infection.…”

“…The availability of direct‐acting antivirals (DAA) against HCV is expected to reduce the incidence of cirrhosis, the rate of liver decompensation, the development of hepatocellular carcinoma, and as a consequence, the overall mortality among HCV patients . Moreover, these new drugs provide the potential to reduce the burden of HCV infection at the population level; however, to reach such public health benefit, policies are needed in order to improve screening of HCV and access to care, particularly in high‐risk populations . In Italy, treatment with DAA was initially restricted to patients with advanced liver disease, and thereafter, the indication for treatment moved to the less severe stages .…”

“…8 Moreover, these new drugs provide the potential to reduce the burden of HCV infection at the population level; however, to reach such public health benefit, policies are needed in order to improve screening of HCV and access to care, particularly in high-risk populations. 9 In Italy, treatment with DAA was initially restricted to patients with advanced liver disease, and thereafter, the indication for treatment moved to the less severe stages. 10 Early treatment of infected individuals is needed to reduce the risk of hepatocellular carcinoma occurrence.…”