Antiviral therapy in hepatitis C virus cirrhotic patients with compensated and decompensated condition

Research output: Contribution to journalArticle

Abstract

The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance (SVR), halt disease progression, and prevent reinfection of the liver graft. However, while the medical need is great, the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias. We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis, due to hepatitis C virus (HCV) infection. In cases presenting with bridging fibrosis or cirrhosis, current regimens of antiviral therapy have attained a 44%-48% rate of SVR. In cirrhotic patients with portal hypertension, the SVR rate was 22% overall, 12.5% in patients with genotype 1, and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin. In patients with decompensated cirrhosis, full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall, 16% in patients with genotype 1 and 4, and 59% in those with genotype 2 and 3. Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects. Major benefits after HCV eradication were partial recovery of liver metabolic activity, prevention of hepatitis C recurrence after transplantation, and removal of some patients from the waiting list for liver transplant. Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve (Child-Pugh-Turcotte score ≥ 10). Although SVR rates are low in decompensated cirrhotics due to hepatitis C, these patients have the most to gain as successful antiviral therapy is potentially lifesaving.

Original languageEnglish
Pages (from-to)6467-6472
Number of pages6
JournalWorld Journal of Gastroenterology
Volume14
Issue number42
DOIs
Publication statusPublished - Nov 14 2008

Fingerprint

Hepacivirus
Antiviral Agents
Ribavirin
Genotype
Fibrosis
Therapeutics
Liver
Hepatitis C
Transplants
Waiting Lists
Portal Hypertension
Virus Diseases
Liver Cirrhosis
Interferons
Disease Progression
Transplantation
Cytokines
Recurrence

Keywords

  • Cirrhosis
  • Hepatitis C virus
  • Peg-interferon
  • Ribavirin
  • Therapy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Antiviral therapy in hepatitis C virus cirrhotic patients with compensated and decompensated condition. / Iacobellis, Angelo; Ippolito, Antonio; Andriulli, Angelo.

In: World Journal of Gastroenterology, Vol. 14, No. 42, 14.11.2008, p. 6467-6472.

Research output: Contribution to journalArticle

@article{dc7b39b6ef644bc28815c3b037e0b9e4,
title = "Antiviral therapy in hepatitis C virus cirrhotic patients with compensated and decompensated condition",
abstract = "The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance (SVR), halt disease progression, and prevent reinfection of the liver graft. However, while the medical need is great, the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias. We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis, due to hepatitis C virus (HCV) infection. In cases presenting with bridging fibrosis or cirrhosis, current regimens of antiviral therapy have attained a 44{\%}-48{\%} rate of SVR. In cirrhotic patients with portal hypertension, the SVR rate was 22{\%} overall, 12.5{\%} in patients with genotype 1, and 66.7{\%} in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin. In patients with decompensated cirrhosis, full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35{\%} overall, 16{\%} in patients with genotype 1 and 4, and 59{\%} in those with genotype 2 and 3. Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects. Major benefits after HCV eradication were partial recovery of liver metabolic activity, prevention of hepatitis C recurrence after transplantation, and removal of some patients from the waiting list for liver transplant. Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve (Child-Pugh-Turcotte score ≥ 10). Although SVR rates are low in decompensated cirrhotics due to hepatitis C, these patients have the most to gain as successful antiviral therapy is potentially lifesaving.",
keywords = "Cirrhosis, Hepatitis C virus, Peg-interferon, Ribavirin, Therapy",
author = "Angelo Iacobellis and Antonio Ippolito and Angelo Andriulli",
year = "2008",
month = "11",
day = "14",
doi = "10.3748/wjg.14.6467",
language = "English",
volume = "14",
pages = "6467--6472",
journal = "World Journal of Gastroenterology",
issn = "1007-9327",
publisher = "WJG Press",
number = "42",

}

TY - JOUR

T1 - Antiviral therapy in hepatitis C virus cirrhotic patients with compensated and decompensated condition

AU - Iacobellis, Angelo

AU - Ippolito, Antonio

AU - Andriulli, Angelo

PY - 2008/11/14

Y1 - 2008/11/14

N2 - The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance (SVR), halt disease progression, and prevent reinfection of the liver graft. However, while the medical need is great, the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias. We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis, due to hepatitis C virus (HCV) infection. In cases presenting with bridging fibrosis or cirrhosis, current regimens of antiviral therapy have attained a 44%-48% rate of SVR. In cirrhotic patients with portal hypertension, the SVR rate was 22% overall, 12.5% in patients with genotype 1, and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin. In patients with decompensated cirrhosis, full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall, 16% in patients with genotype 1 and 4, and 59% in those with genotype 2 and 3. Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects. Major benefits after HCV eradication were partial recovery of liver metabolic activity, prevention of hepatitis C recurrence after transplantation, and removal of some patients from the waiting list for liver transplant. Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve (Child-Pugh-Turcotte score ≥ 10). Although SVR rates are low in decompensated cirrhotics due to hepatitis C, these patients have the most to gain as successful antiviral therapy is potentially lifesaving.

AB - The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance (SVR), halt disease progression, and prevent reinfection of the liver graft. However, while the medical need is great, the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias. We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis, due to hepatitis C virus (HCV) infection. In cases presenting with bridging fibrosis or cirrhosis, current regimens of antiviral therapy have attained a 44%-48% rate of SVR. In cirrhotic patients with portal hypertension, the SVR rate was 22% overall, 12.5% in patients with genotype 1, and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin. In patients with decompensated cirrhosis, full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall, 16% in patients with genotype 1 and 4, and 59% in those with genotype 2 and 3. Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects. Major benefits after HCV eradication were partial recovery of liver metabolic activity, prevention of hepatitis C recurrence after transplantation, and removal of some patients from the waiting list for liver transplant. Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve (Child-Pugh-Turcotte score ≥ 10). Although SVR rates are low in decompensated cirrhotics due to hepatitis C, these patients have the most to gain as successful antiviral therapy is potentially lifesaving.

KW - Cirrhosis

KW - Hepatitis C virus

KW - Peg-interferon

KW - Ribavirin

KW - Therapy

UR - http://www.scopus.com/inward/record.url?scp=63449110734&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=63449110734&partnerID=8YFLogxK

U2 - 10.3748/wjg.14.6467

DO - 10.3748/wjg.14.6467

M3 - Article

C2 - 19030197

AN - SCOPUS:63449110734

VL - 14

SP - 6467

EP - 6472

JO - World Journal of Gastroenterology

JF - World Journal of Gastroenterology

SN - 1007-9327

IS - 42

ER -