Direct antiviral agents in hepatitis C virus related liver disease: Don’t count the chickens before they’re hatched

Table 1 Benefits and pitfalls of sustained virological response using direct-acting antivirals in different hepatitis C virus scenarios

Setting	Benefits	Pitfalls
Advanced liver disease	SVR rates higher than 95%; Reduced risk of decompensation and deathHVPG reduction	Nothing to report
Decompensated cirrhosis	Liver function improvement in one third to one half of patients; Treatment well-tolerated	Slightly lower SVR rates; Need for ribavirin or treatment elongation to 24 wk
HCC occurrence	Reduced occurrence of HCC	Still relevant risk of HCC; Need for periodic surveillance for early diagnosis
HCC recurrence	Improved survival due to reduced risk of decompensation	Risk of HCC recurrence unaffected by SVR; Need for periodic surveillance for early diagnosis
Diabetes	Reduced incidence of diabetes; Improvement of glycemic control	Risk of hypoglycemia in patients receiving antidiabetic medications; Adjustments of antidiabetic medication may be necessary
Cardiovascular diseases	Decreased risk of cardiovascular events; Reduction in cardiovascular deaths	Nothing to report
HBV coinfection	As for general HCV population	Risk for HBV reactivation; Pre-DAA screening for HBV indicated; Need for HBV treatment or on-treatment HBV monitoring as requested

DAA: Direct-acting antiviral; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; HVPG: Hepatic venous pressure gradient; SVR: Sustained virological response.