Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4669
Peer-review started: January 24, 2017
First decision: March 16, 2017
Revised: March 28, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: July 14, 2017
Chronic hepatitis C is a leading cause of morbidity and mortality, mainly related to fibrosis/cirrhosis and portal hypertension. Direct antiviral agents are highly effective and safe and can now cure > 90% of the patients. Sustained viral response (SVR) after interferon-based regimens has been associated with improvement in liver function, fibrosis and portal hypertension in a significant proportion of patients, although a point of no return seems to exist from which viral elimination is no longer capable of preventing portal hypertension progression and liver decompensation. Indeed, although SVR is associated with improvement of hepatic venous pressure gradients and therefore a decreased risk of de novo esophageal varices, several studies show that viral clearance does not eliminate the risk of variceal progression, liver decompensation and death in patients with pre-established portal hypertension. Although evidence about the effects of direct antiviral agents (DAAs) on clinically significant outcomes is still scarce and with short follow-up, DAAs can decrease the burden of the disease if patients are timely treated before significant fibrosis and portal hypertension develops. Studies with longer follow-up are waited to establish the real magnitude of hepatitis C treatment on portal hypertension. Future studies should also focus on predictors of portal hypertension resolution since it can influence management and avoid unnecessary monitoring
Core tip: Hepatitis C is associated with significant morbidity and mortality, mainly through portal hypertension complications. Hepatitis C treatment is associated with improvement of liver function and fibrosis, better quality of life and reduced mortality. The knowledge of the impact of viral clearance on portal hypertension is also relevant because it greatly influences clinical outcomes and can influence management after treatment. Several studies show that the benefits on portal hypertension are higher if treatment is delivered before clinically significant portal hypertension is developed, encouraging timely and early treatment with the highly efficacious and safe direct antiviral agents.