Regimens for Cirrhotic Patients

Clin Liver Dis. 2015 Nov;19(4):657-67, vi. doi: 10.1016/j.cld.2015.06.006. Epub 2015 Jul 26.

Abstract

Therapy for hepatitis C has entered the era of all-oral direct-acting antiviral agents. Sustained response rates are now greater than 90% for all genotypes, although patients with cirrhosis remain the most difficult to treat. There are limited data for patients with cirrhosis and with hepatitis C genotypes 4 and 6 with cirrhosis. Genotype 3 patients with cirrhosis need additional strategies to achieve the sustained virologic response rates seen in genotype 1 patients with cirrhosis. This article outlines the currently available therapies for patients with cirrhosis and hepatitis C across all genotypes, with suggested management strategies.

Keywords: Cirrhosis; Direct-acting antivirals; Hepatitis C; Ledipasvir; Ombitasvir; Paritaprevir; Simeprevir; Sofosbuvir.

Publication types

  • Review

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Drug Therapy, Combination
  • Genotype
  • Hepacivirus / genetics
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / virology*
  • Nucleic Acid Synthesis Inhibitors / therapeutic use*
  • Protease Inhibitors / therapeutic use
  • RNA, Viral / biosynthesis
  • Retreatment
  • Treatment Failure
  • Viral Nonstructural Proteins / antagonists & inhibitors

Substances

  • Antiviral Agents
  • Nucleic Acid Synthesis Inhibitors
  • Protease Inhibitors
  • RNA, Viral
  • Viral Nonstructural Proteins
  • NS-5 protein, hepatitis C virus