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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 8, 2017; 9(7): 352-367
Published online Mar 8, 2017. doi: 10.4254/wjh.v9.i7.352
Future of liver disease in the era of direct acting antivirals for the treatment of hepatitis C
Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Gian Lodovico Rapaccini, Maurizio Pompili, Antonio Gasbarrini
Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
Gian Lodovico Rapaccini, Gastroenterology, Catholic University Sacred Heart of Rome, Complesso Integrato Columbus, 00168 Rome, Italy
Author contributions: Ponziani FR, Mangiola F and Binda C reviewed the literature, drafted the paper and approved the final version of the paper; Zocco MA, Siciliano M, Grieco A, Rapaccini GL, Pompili M and Gasbarrini A reviewed the literature, revised the paper and approved the final version of the paper.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
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: Cecilia Binda, MD, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168 Rome, Italy. cecilia.binda@gmail.com
Telephone: +39-6-30156265
Received: September 2, 2016
Peer-review started: September 3, 2016
First decision: October 20, 2016
Revised: October 26, 2016
Accepted: December 1, 2016
Article in press: December 2, 2016
Published online: March 8, 2017
Processing time: 184 Days and 19 Hours
Abstract

Hepatitis C virus (HCV) infection has been a global health problem for decades, due to the high number of infected people and to the lack of effective and well-tolerated therapies. In the last 3 years, the approval of new direct acting antivirals characterized by high rates of virological clearance and excellent tolerability has dramatically improved HCV infection curability, especially for patients with advanced liver disease and for liver transplant recipients. Long-term data about the impact of the new direct acting antivirals on liver fibrosis and liver disease-related outcomes are not yet available, due to their recent introduction. However, previously published data deriving from the use of pegylated-interferon and ribavirin lead to hypothesizing that we are going to observe, in the future, a reduction in mortality and in the incidence of hepatocellular carcinoma, as well as a regression of fibrosis for people previously affected by hepatitis C. In the liver transplant setting, clinical improvement has already been described after treatment with the new direct acting antivirals, which has often led to patients delisting. In the future, this may hopefully reduce the gap between liver organ request and availability, probably expanding liver transplant indications to other clinical conditions. Therefore, these new drugs are going to change the natural history of HCV-related liver disease and the epidemiology of HCV infection worldwide. However, the global consequences will depend on treatment accessibility and on the number of countries that could afford the use of the new direct acting antivirals.

Keywords: Direct acting antivirals; Hepatitis C; Liver transplantation; Liver fibrosis; Cirrhosis; Hepatocellular carcinoma

Core tip: The approval of new direct acting antivirals with high rates of virological clearance and excellent tolerability has dramatically improved hepatitis C virus (HCV) infection curability, especially for patients with advanced liver disease and for liver transplant recipients. The aim of this review is to draw the possible future scenery in HCV-related liver disease, focusing our attention on the impact of second generation direct acting antivirals on liver fibrosis, hepatocellular carcinoma and liver transplantation.