Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.2931
Peer-review started: January 31, 2020
First decision: February 24, 2020
Revised: March 26, 2020
Accepted: May 30, 2020
Article in press: May 30, 2020
Published online: June 14, 2020
More than five years ago, the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral (DAA) drugs. They proved highly efficient in curing patients with chronic hepatitis C (CHC), including patients with cirrhosis. The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis, but the exact cause of the expected benefit was unclear. Further, little was known about how the underlying liver disease would be affected during and after viral clearance. In this review, we describe and discuss the liver-related effects of the new treatments in regards to both pathophysiological aspects, such as macrophage activation, and the time-dependent effects of therapy, with specific emphasis on inflammation, structural liver changes, and liver function, as these factors are all related to morbidity and mortality in CHC patients. It seems clear that antiviral therapy, especially the achievement of a sustained virologic response has several beneficial effects on liver-related parameters in CHC patients with advanced liver fibrosis or cirrhosis. There seems to be a time-dependent effect of DAA therapy with viral clearance and the resolution of liver inflammation followed by more discrete changes in structural liver lesions. These improvements lead to favorable effects on liver function, followed by an improvement in cognitive dysfunction and portal hypertension. Overall, the data provide knowledge on the several beneficial effects of DAA therapy on liver-related parameters in CHC patients suggesting short- and long-term improvements in the underlying disease with the promise of an improved long-term prognosis.
Core tip: Antiviral therapy of chronic hepatitis C, especially the achievement of a sustained virologic response, has several beneficial effects on liver-related parameters in chronic hepatitis C patients. There seems to be a time-dependent effect of therapy. Initially, liver inflammation ameliorates, followed by more discrete changes in structural liver lesions. These improvements are followed by beneficial effects on liver function, cognitive disturbances, and portal hypertension. Together, this suggests short- and long-term improvements in the underlying liver disease with the promise of an improved prognosis.