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World J Hepatol. Jul 18, 2015; 7(14): 1843-1855
Published online Jul 18, 2015. doi: 10.4254/wjh.v7.i14.1843
Hepatitis C cirrhosis: New perspectives for diagnosis and treatment
Vikas Khullar, Roberto J Firpi
Vikas Khullar, Roberto J Firpi, Department of Medicine, University of Florida College of Medicine, Gainesville, FL 32608, United States
Roberto J Firpi, Section of Hepatobiliary Diseases and Transplantation, University of Florida College of Medicine, Gainesville, FL 32608, United States
Author contributions: Khullar V and Firpi RJ contributed to this work.
Conflict-of-interest statement: The authors have no conflict of interest in the publication of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Roberto J Firpi, MD, MS, AGAF, Section of Hepatobiliary Diseases and Transplantation, University of Florida College of Medicine, 1600 S.W. Archer Road, MSB- 440, Gainesville, FL 32608, United States. roberto.firpi@medicine.ufl.edu
Telephone: +1-352-2739466 Fax: +1-352-3927393
Received: November 27, 2014
Peer-review started: November 29, 2014
First decision: January 8, 2015
Revised: June 21, 2015
Accepted: July 7, 2015
Article in press: July 8, 2015
Published online: July 18, 2015
Processing time: 239 Days and 9.3 Hours
Abstract

Chronic hepatitis C infection is the leading cause of chronic liver disease, cirrhosis, hepatocellular carcinoma as well as the primary indication for liver transplantation in the United States. Despite recent advances in drugs for the treatment of hepatitis C, predictive models estimate the incidence of cirrhosis due to hepatitis C infection will to continue to rise for the next two decades. There is currently an immense interest in the treatment of patients with fibrosis and early-stage cirrhosis as treatment can lead to decrease in the rates of decompensated cirrhosis, hepatocellular carcinoma and need for liver transplantation in these patients. The goal of this paper is to provide clinicians and health care professionals further information about the treatment of patients with hepatitis C infection and cirrhosis. Additionally, the paper focuses on the disease burden, epidemiology, diagnosis and the disease course from infection to treatment. We provide an overview of multiple studies for the treatment of chronic hepatitis C infection that have included patients with cirrhosis. We also discuss the advantages and disadvantages of treatment in cirrhotic patients and focus on the most up to date guidelines available for treatment.

Keywords: Cirrhosis, Diagnosis, Treatment, Simeprevir, Sofosbuvir, Ledipasvir, Liver transplantation, Hepatitis C virus

Core tip: The treatment of chronic hepatitis C infection has undergone a revolution with the introduction of new and highly-effective therapies allowing for high rates of cure and relatively low adverse effects. While there is strong evidence for the treatment of patients without cirrhosis, limited studies and numbers are available for patients with cirrhosis; yet this is the group likely to benefit most from treatment. This paper focuses on the current evidence and regimens for the treatment of patients with cirrhosis and addresses the advantages and disadvantages of pursuing treatment.