COMMENTARY

Hepatitis C: Let's Get 'Real'

Digestive Disease Week (DDW) 2016

William F. Balistreri, MD

Disclosures

June 24, 2016

In This Article

Special Populations

Patients With Decompensated Cirrhosis

Treatment with SOF/VEL regimens demonstrated high efficacy rates in patients infected with HCV genotypes 1-6 with decompensated cirrhosis.

Brown and colleagues[12] explored the effect of viral clearance on clinical outcomes and also attempted to identify key clinical and laboratory parameters associated with changes in MELD scores in patients who achieve SVR. The overall SVR12 rates in 267 patients who were randomly assigned and treated were 83% (SOF/VEL for 12 weeks), 94% (SOF/VEL + ribavirin for 12 weeks), and 86% (SOF/VEL for 24 weeks). Treatment with SOF/VEL regimens had high efficacy rates in patients with decompensated cirrhosis. Patients who achieved SVR12 had a higher probability of clinical improvement if they had a higher MELD score, lower BMI, or the absence of ascites and encephalopathy at the time of enrollment.

Cirrhotic Patients Awaiting Liver Transplantation

HCV-associated cirrhosis is the most common indication for liver transplantation (LT) among adults in the United States. Recurrence of HCV is universal for those with ongoing viremia and is associated with accelerated allograft fibrosis progression and higher rates of allograft failure and death.

Njei and colleagues[13] evaluated the comparative cost-effectiveness of treating HCV pre-LT versus post-LT in the event of HCV recurrence. In this base-case analysis, the investigators found that treatment of HCV post-LT led to $70,224 more in spending per quality-adjusted life-year (QALY) compared with pre-LT treatment. In a sensitivity analysis, post-LT treatment led to $98,275 more spent per QALY for patients without hepatocellular carcinoma (HCC) and $41,040 more spent per QALY for those with HCC compared with pre-LT treatment. They estimated that treating 100,000 patients with HCV prior to liver transplantation would prevent 182 cases of liver failure, 139 cases of HCC, 194 transplantations, and 858 liver-related deaths. They concluded that treatment of HCV prior to liver transplantation is more cost-effective and is associated with improved liver-related outcomes compared with delaying treatment until post-LT HCV recurrence.

Prior DAA Therapy Failure

Optimal strategies for the retreatment of patients with prior DAA treatment failure are still not clear.

Poordad and colleagues[14] investigated the safety and efficacy of ombitasvir/paritaprevir/ritonavir and dasabuvir plus sofosbuvir with or without ribavirin in DAA-experienced patients with HCV genotype 1 infection. High SVR12 rates were achieved with this multitargeted regimen in patients who failed prior DAA treatment, including those who had previously failed three DAA regimens and those with NS5A resistance-associated variants.

Asian American Patients

Le and colleagues[15] characterized the rate of progression to cirrhosis and hepatic decompensation in patients of various ethnicities who were diagnosed with chronic HCV infection. Out of a total of 9451 patients, 972 were Asian. Asian patients were significantly older than non-Asian patients and were more likely to have at least two comorbidities; a higher proportion had diabetes mellitus, hypertension, coronary artery disease, and chronic kidney disease. The 10-year cumulative incidence of cirrhosis and hepatic decompensation was significantly higher in Asian patients. On multivariate analysis, ethnicity, older age, male sex, no SVR, and Asian ethnicity were significant independent predictors for cirrhosis and failure to achieve an SVR. Asian ethnicity was a significant predictor for hepatic decompensation.

Early treatment with DAAs that results in successful SVR may decrease the rate of progression to cirrhosis and hepatic decompensation for all patients with hepatitis C, but especially for those who are at highest risk.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....