Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.62
Peer-review started: March 6, 2021
First decision: July 27, 2021
Revised: August 2, 2021
Accepted: December 9, 2021
Article in press: December 9, 2021
Published online: January 27, 2022
Loss of follow-up or reinfections hinder the expectations of hepatitis C eradication despite the existence of highly effective treatments. Moreover, the elimination of the infection does not imply the reversion of those chronic alterations derived from the previous infection by hepatitis C virus (HCV). This review analyzes the risk factors associated with loss to follow-up in diagnosis or treatment, and the possibility of reinfection. Likewise, it assesses the residual alterations induced by chronic HCV infection considering the liver alterations (inflammation, fibrosis, risk of decompensation, hepatocellular carcinoma, liver transplantation) and, on the other hand, the comorbidities and extrahepatic manifestations (cryoglobulinemia, non-Hodgkin lymphoma, peripheral insulin resistance, and lipid, bone and cognitive alterations). Peculiarities present in subjects coinfected with human immunodeficiency virus are analyzed in each section.
Core Tip: The excellent hepatitis C virus (HCV) response to direct acting agents should not obviate certain obstacles to eradicate this pathology, especially the loss to follow-up and the possibility of reinfections. Chronic hepatitis C determines persistent alterations despite the elimination of HCV, such as liver dysfunction and continued risk of decompensation and hepatocarcinoma, especially in subjects treated in advanced stages of the disease. Weight gain after sustained virological response (SVR) may favor liver steatosis, increasing the risk of progression of hepatic disease. The probability of complications after SVR in human immunodeficiency virus coinfected patients is similar to that of those HCV-monoinfected.