Review treatment chronic hepatitis c virus infection cirrhosis

Abstract Background: Cirrhosis developing during chronic infection with the hepatitis C virus HCV poses a risk of anticipated liver-related death, therefore representing a dominant indication to anti-HCV therapy. Publication types Research Support, Non-U. Gov't Review. Currently available treatments Similar to HAV infection, the majority of patients with acute HEV infection require no specific treatment and the management is mostly supportive.

Ongoing research and future directions For chronic HEV patients who fail ribavirin therapy, some alternatives such as PEG-interferon[ ] and sofosbuvir are being considered pending more evidence[ ]. Role of liver transplant Although liver transplant recipients may develop chronic HEV in the setting of prolonged immunosuppression, acute HEV infection may rarely result in acute liver failure necessitating liver transplant.

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Fulminant hepatic failure in acute hepatitis C: increased risk in chronic carriers of hepatitis B virus. Extrahepatic manifestations associated with hepatitis C virus infection. There is no current established treatment for patients with genotype 4, 5 or 6. These patients are usually treated with the same regimen used for genotype 1 patients El-Zayadi et al , An optimal treatment regimen for acute hepatitis C has not yet been established.

Hence, a delay of treatment for 8—12 weeks after the onset of acute hepatitis C has been suggested. Both IFN and peginterferon with or without the combination of ribavirin have been used in various studies with promising results.

There are three types of response to therapy: SVR, relapse or breakthrough, and non-response. ALT levels return to normal and liver histology shows improvement. Various factors have been associated with lower response rates in patients undergoing treatment with peginterferon and ribavirin. Hence, these factors should be reviewed when considering therapy. Treatment with peginterferon and ribavirin is associated with numerous adverse effects Table 3. Most patients undergoing treatment experience side effects ranging from mild to severe.

As a result, patient education of potential side effects as well as monthly visits for monitoring blood counts and symptoms should be emphasized before the initiation of therapy. The most common side effects of peginterferon are fatigue, muscle aches and psychological side effects such as depression, anxiety, irritability and sleep disturbance.

The most common side effect of ribavirin is hemolytic anemia, which usually warrants dose reduction. Many new approaches to therapy of chronic hepatitis C are being studied in clinical trials.

Some of the recent advances have been made in the modification of the dose and duration of current recommended combination therapy. Ribavirin in high doses — mg has been shown to achieve higher SVR rates in a small trial at the expense of a higher toxicity profile Lindahl et al , New forms of IFN are being tested clinically.

A new generation of small molecule inhibitors targeting the viral-encoded enzymes, such as the proteases and polymerases is being developed. Many of them are in late phase clinical trials Pawlotsky, Although some of them are quite promising in suppressing HCV levels in HCV-infected people, drug resistant mutants emerge rapidly after the initiation of therapy.

Therefore they would have to be used in combination with IFN-based therapy. Treatment of hepatitis C has improved substantially in response rates across all genotypes.

However, progress remains to be made to improve the SVR rates for genotype 1 patients as well as relapsers and non-responders. Until the above-discussed new agents pass rigorous scrutiny in clinical trials, the current combination therapy of peginterferon and ribavirin will remain the mainstay treatment of hepatitis C for the next 3—5 years.

National Center for Biotechnology Information , U. Oral Dis. Author manuscript; available in PMC Jan 8. Author information Copyright and License information Disclaimer. Copyright notice.

The publisher's final edited version of this article is available at Oral Dis. See other articles in PMC that cite the published article. Abstract Hepatitis C is a major cause of chronic liver disease. In patients with compensated cirrhosis Child-Pugh-Turcotte CTP class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce.