The Benefits of Hepatitis C Virus Cure: Every Rose Has Thorns

D. Salmon; M. U. Mondelli; M. Maticic; J. E. Arends

Disclosures

J Viral Hepat. 2018;25(4):320-328. 

In This Article

Abstract and Introduction

Abstract

To examine mid–term benefits on hepatic complications, extrahepatic clinical syndromes and quality of life associated with HCV cure; to review the few safety issues linked to oral direct–acting antivirals (DAAs); and to discuss the potential population benefits of reducing the burden of HCV infection. DAAs cure HCV infection in more than 95% of patients. The halting of liver inflammation and fibrosis progression translates into both hepatic and extrahepatic benefits and reduces the need for liver transplantation. A reduction in the frequency of extrahepatic manifestations such as mixed cryoglobulinaemia and vasculitis and improvements in quality of life and fatigue have also been described. A few safety issues linked to DAAs such as the potential recurrence of aggressive HCC, the flares of hepatitis B virus in patients with overt or occult HBV infection are been discussed. Curing HCV infection also has a high potential to reduce the burden of HCV infection at the population level. With widespread scaling up of HCV treatment, several modeling studies suggest that major reductions in HCV prevalence and incidence are possible, and that elimination of viral hepatitis is an achievable target by 2030.

Introduction

Oral therapy with direct–acting antivirals (DAAs) against hepatitis C virus (HCV) offers very effective and short–course treatment leading to HCV cure in more than 95% of patients, including those with advanced or decompensated cirrhosis.[1] This virological cure has beneficial consequences, reducing liver inflammation and reversing fibrosis progression, which have been shown to reduce cirrhosis–related complications, including hepatocellular carcinoma (HCC).[2] In addition, reducing systemic inflammation and immune activation secondary to HCV replication reduces the frequency of extrahepatic manifestations such as mixed cryoglobulinaemia and vasculitis, cutaneous and renal disorders, fatigue and depression, atherosclerosis, and type 2 diabetes. However, despite viral eradication, existing liver disease and possible extrahepatic manifestations may not immediately be cured.

Curing HCV infection does not only benefit the infected individual but also provides a high potential to reduce the burden of HCV infection at the population level. Several modelling studies suggested that dramatic reductions in HCV prevalence and incidence are possible with widespread scaling up of HCV treatment.[3,4] However, these population benefits necessitate highly motivated national policies to improve HCV screening and access to care, particularly in high–risk populations, as well as drug cost reductions and improved prevention.

The aim of this review was to examine mid–term liver complications and extrahepatic clinical syndromes, in addition to the quality–of–life benefits, associated with HCV cure (Figure 1). We also review the few safety issues linked to DAAs (potential recurrence of aggressive HCC, flares of hepatitis B virus (HBV)) and discuss the potential population benefits of the reduction in the burden of HCV infection.

Figure 1.

Overview of benefits and challenges after HCV cure

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