Treatment of hepatitis C virus infection in patients with cirrhosis and predictive value of model for end‐stage liver disease: Analysis of data from the Hepa‐C registry

Section: Discussionmentioning

confidence: 99%

Follow‐up of sustained virological responders with hepatitis C and advanced liver disease after interferon/ribavirin‐free treatment

Kozbial

Moser

Al‐Zoairy

et al. 2017

“…The advent of highly effective direct‐acting antivirals (DAAs) has revolutionized treatment for HCV infection with successful viral eradication (termed sustained virological response, SVR or cure) even in patients with advanced liver disease or significant portal hypertension . However, in clinical trials as well as in clinical practice, patients with cirrhosis exhibited reduced SVR rates, <90% in different series, mainly among decompensated liver disease groups. Therefore, increased treatment duration or addition of RBV is frequently used in decompensated cirrhotic patients or in genotype‐3 HCV‐infected compensated cirrhotic patients, in an effort to improve response rates…”

Section: Introductionmentioning

confidence: 99%

Early HCV viral kinetics under DAAs may optimize duration of therapy in patients with compensated cirrhosis

Gambato

Canini

Lens

et al. 2018

Self Cite

Background & Aims Detailed hepatitis C virus (HCV) kinetics modelling is scarce in patients with advanced liver disease receiving direct‐acting antivirals (DAAs). Due to budget restrictions, patients and health systems would benefit from the shortest possible treatment course. We investigated whether modelling very early HCV kinetics in cirrhotic patients under DAAs therapy could be used to individualize care and reduce treatment duration to achieve cure. Methods We included 74 patients with HCV‐related cirrhosis who received interferon‐free treatments for 12‐24 weeks. HCV genotype, liver disease stage and treatment regimen were recorded. Viral load was determined prospectively at very frequent intervals until target not detected (TND, <15 IU/mL). A viral kinetic model was used to predict time to cure based on HCV clearance in extracellular body fluid (CL‐EF). Results Sixty‐eight patients (92%) achieved cure. Thirteen (18%) had MELD ≥15, 35 (47%) were Child‐Pugh (CTP) ≥7. Median time to reach TND was 2 weeks (IQR: 1‐4 weeks). Modelling indicated an average DAAs efficacy in blocking viral production of ε = 99.1%. HCV half‐life (t1/2) was significantly shorter in patients with CTP <7, LSM <21 kPa or MELD <15 (1.5 vs 2.5 hours; P = 0.0057). The overall median CL‐EF was 5.6 weeks (4.1‐7.8). A CTP >7 and a LSM ≥21 kPa were significantly (P = 0.016) associated with longer CL‐EF. Conclusions The study provides insights into HCV dynamics during DAAs therapy in patients with compensated and decompensated cirrhosis. Viral kinetics modelling suggests that treatment duration may be optimized in patients with compensated cirrhosis.

“…There is an abundance of data on the clinical improvement of Dec‐HCV patients following HCV eradication. Overall, a sustained virological response (SVR) is associated with a median 2‐point reduction in MELD score, a lower incidence of decompensation over 12 months post‐SVR, and a 30% chance of delisting . In the European study coordinated by Belli et al., and involving 11 European centres, 38/142 treated patients were delisted .…”

Section: How To Deal With Direct‐acting Antiviral Treatment Failure Bmentioning

confidence: 99%

Specific issues concerning the management of patients on the waiting list and after liver transplantation

Burra

Giannini

Caraceni

et al. 2018

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system.