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Cirrhosis and When to Treat Hepatitis C

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Hepatitis C antiviral therapy had been reserved primarily for those in the earlier stages of liver disease. However, new research suggests that those with a certain type of cirrhosis should begin treatment as well.

The Hepatitis C virus (HCV) is a prevalent and potentially fatal infectious virus that invades the liver. If the virus is not stopped, it could be the source of progressive liver damage that is capable of shutting down the liver completely. While lifestyle choices and herbal supplements can delay HCV from causing advanced liver disease, the only sure way to stay healthy is by eliminating the virus. For the most common strain of Hepatitis C in America (genotype 1), the current antiviral treatment for Hepatitis C is only about 50 percent effective at viral elimination. In addition, the treatment can cause severe, debilitating side effects and is expensive. Thus, physicians are required to weigh various treatment pros and cons to decide who should and should not be an HCV antiviral therapy recipient.

Progression of HCV

Hepatitis C has been nicknamed a silent disease, because there are typically few to no symptoms until the illness has progressed to advanced liver disease. Liver damage is not caused directly by the Hepatitis C virus; instead, it is caused by the immune system attacking and destroying the liver cells where HCV has taken up residence. If not treated promptly and successfully, chronic Hepatitis C infection can progress in the following manner:

  1. Fibrosis – Due to its ability to regenerate, the liver can recover from occasional damage. However, when liver cells are repeatedly attacked, it can scar the liver. Also known as fibrosis, scarring of liver tissue may be reversible.
  2. Cirrhosis – When a fibrotic liver is subjected to repeated, excessive scarring, it shrinks and undergoes a textural change from soft and supple to hard and knobby. Also known as cirrhosis, this severe scarring usually takes years to develop and is considered to be irreversible.
  3. Liver Failure – If a liver with cirrhosis remains under continual attack from HCV, the illness can advance even further. Known as end-stage liver disease, liver failure occurs when there are not enough functioning liver cells to sustain life. At this point, a liver transplant is one of the only remaining options.

Cirrhosis Differentiation

A sure sign of advanced liver disease, there are actually two stages of cirrhosis: compensated and decompensated.

  • Compensated Cirrhosis – This earlier stage of cirrhosis involves a heavily scarred liver that can still perform many of its important functions. Individuals with compensated cirrhosis may be symptom-free and complication-free; however, this stage of illness can progress in severity very fast.
  • Decompensated Cirrhosis – This later stage of cirrhosis means that the liver is severely scarred and unable to function properly. People with decompensated cirrhosis eventually develop many symptoms and potentially life-threatening complications.

HCV Treatment With Cirrhosis

Experts estimate that approximately 10 to 25 percent of people with chronic HCV will develop cirrhosis. Traditionally, those with cirrhosis have not been considered to be good candidates for Hepatitis C therapy, because their bodies are less able to cope with the medications. Thus, treatment is generally administered before cirrhosis develops. However, new research changes that conception.

As published in the June 2010 issue of Liver Transplantation, researchers at the UCLA Medical Center found that antiviral therapy during compensated cirrhosis is the most cost-effective approach to treating patients with advanced liver disease due to Hepatitis C. The study population of 4,000 patients was evenly divided into four different groups:

  1. Control – did not receive antiviral treatment
  2. Compensated Cirrhosis – received antiviral treatment
  3. Decompensated Cirrhosis – received antiviral treatment
  4. HCV Recurrence After Liver Tansplant – received antiviral treatment after developing advanced fibrosis from the return of Hepatitis C

Resulting in improved survival and decreased cost when compared with the other strategies, the UCLA researchers concluded that antiviral therapy for patients with compensated cirrhosis is the most cost-effective strategy. Participants in the other groups receiving treatment (decompensated cirrhosis and HCV recurrence post liver transplant) were also found to be cost-effective, but these patients derived less survival benefit at greater cost when compared to those with compensated cirrhosis.

Although many new medications for treating HCV are on the fast track to approval, the current antiviral treatment remains a challenging treatment to endure. For this reason, those with cirrhosis have often been considered to be poor candidates for Hepatitis C treatment. Since UCLA’s new study demonstrates that HCV antiviral treatment is cost-effective and increases the survival rate for people with compensated cirrhosis, those with advanced liver disease have a better chance of beating this virus. In addition, this new information serves as encouragement for those with the early stage of cirrhosis to avoid delay and seek HCV treatment right away.

References:, Antiviral therapy during compensated cirrhosis most cost-effective approach, Retrieved June 1, 2010,, 2010., Cirrhosis in Chronic Hepatitis C Infection, Jorge L. Herrera, MD, Retrieved June 1, 2010, Hepatitis C Support Project, 2010., Disease Progression: What is Cirrhosis?, Alan Franciscus, Retrieved June 2, 2010, Hepatitis C Support Project, 2010., Antiviral therapy during compensated cirrhosis most cost-effective approach, Retrieved June 1, 2010,, 2010., Timing of hepatitis C antiviral therapy in patients with advanced liver disease: A decision analysis model, Sammy Saab, et al, Retrieved June 1, 2010, Liver Transplantation, June 2010.


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