HCV and Cirrhosis
Treatment of HCV in Cirrhotic Patients
By Marina Nunez, MD, PhD
Hepatitis C virus (HCV) infection is considered difficult to treat in patients with cirrhosis. In addition to diminished response to current anti-HCV therapies, these subjects with cirrhosis have a higher risk to develop decompensation of their liver disease and other complications.
Two studies presented at the 40th EASL meeting evaluated the efficacy and safety of treatment of patients with HCV-related liver cirrhosis with interferon (IFN)-based therapies [1,2].
In the Canadian study, these cirrhotic patients in early stage of disease were compared with non-cirrhotics . There were no differences between both groups of patients in adverse events, nor in the proportion of patients undergoing dose modifications.
A trend to have lower responses among cirrhotic subjects compared to non-cirrhotics was observed for all genotypes, being more marked the differences in HCV-1-infected individuals. The authors suggest HCV-infected compensated cirrhotic patients can be successfully treated, and that higher responses may be achieved with optimal doses of RBV (1,000-1,200 mg/day).
In the study from the US, with more advanced liver disease, a higher number of subjects required discontinuation of the HCV treatment, and 3% experienced decompensation of liver disease .
Anemia requiring erythropoietin (EPO), neutropenia requiring G-CSF, and infections occurred in 50%, 16%, and 9% of subjects, respectively. Of notice, 15.6% of the patients were removed from the transplant list due to clinical improvement.
Therefore, treatment of HCV infection in subjects with advanced liver disease may be successful in a subset of well selected patients, especially in those carrying HCV genotypes other than 1. However, more complications arise among these subjects, and although treatment seems to be safe, their follow-up during therapy is very challenging.
- S Lee and others. Peginterferon alfa-2a (40 kD) (PEGASYS®) plus ribavirin (COPEGUS®) in cirrhotic patients with chronic hepatitis C: results of a Canadian multicenter open-label expanded access programme. Abstract 576. 40th EASL. April 13-17, 2005. Paris, France.
- J K Lim and others. Safety and efficacy of antiviral therapy in patients with decompensated cirrhosis associated with chronic hepatitis C infection. Abstract 579. 40th EASL. April 13-17, 2005. Paris, France.
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