Treatment of chronic hepatitis C infection in cirrhotic patients

Abstract

Epidemiologic studies suggest that liver cirrhosis develops after 20 years of active infection with hepatitis C virus (HCV) and that hepatocarcinoma develops after about 30 years of active HCV infection. Liver cirrhosis may be compensated, in which case clinical and biochemical deterioration is absent, or it may be decompensated, in which case progressive deterioration of liver function is evident. Annual rates of decompensation, hepatocarcinoma, and death in patients with decompensated cirrhosis are 3.6%–6%, 1.4%–3.3%, and 2.6%–4%, respectively. Once cirrhosis becomes decompensate, the survival rate in the subsequent five years is 50%. The foregoing justifies recommending treatment for compensate cirrhotic patients with hepatitis C. The safety and efficacy of treatment is acceptable for patients with a Child–Pugh (CP) score less than 7 or a model for end-stage liver disease (MELD) score less than 18 (Table I). Treatment of patients awaiting liver transplantation may be considered provided that it is administered by experienced clinical personnel and that strict vigilance for adverse effects is maintained.