Hepatitis C virus antiviral therapy in patients with cirrhosis

Chronic hepatitis C virus (HCV) infection is generally a slowly progressive disease. A minority of infected patients, however, eventually will develop cirrhosis and its life-threatening complications. Recent development of combination interferon (IFN) and ribavirin (RBV) antiviral therapy has changed the approach to patients infected with the virus. Once cirrhosis develops, treatment is a difficult task and should be done with close monitoring because of numerous adverse effects. In patients with compensated cirrhosis, combination therapy is the most efficient approach and offers the highest sustained virological response. Although data are limited, no significant differences have been reported between the use of pegylated interferon (PEG-IFN) and standard IFN in combination with RBV Moreover, PEG-IFN has a higher risk of hematological complications, and this should be considered when using in advanced disease. Antiviral therapy for patients with decompensated cirrhosis should be used only in a clinical trial setting because of reported severe adverse effects. After liver transplantation, combination therapy may be an alternative for a limited number of patients. Although definitive recommendations cannot be made because of limited studies, there is a group of very well compensated patients with HCV and cirrhosis who benefited from treatment by clinicians well versed in the use of combination therapy.