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World J Gastroenterol. Aug 7, 2021; 27(29): 4831-4845
Published online Aug 7, 2021. doi: 10.3748/wjg.v27.i29.4831
Impact of modern antiviral therapy of chronic hepatitis B and C on clinical outcomes of liver disease
Tiffany Khoo, Danielle Lam, John K Olynyk
Tiffany Khoo, Danielle Lam, John K Olynyk, Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch 6150, Australia
Tiffany Khoo, Danielle Lam, John K Olynyk, School of Medical and Health Sciences, Edith Cowan University, Joondalup 6027, Australia
Author contributions: Khoo T and Lam D contributed to the literature review, writing and editing of manuscript; Olynyk JK contributed to editing of manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: John K Olynyk, FAASLD, AGAF, FRACP, MBBS, MD, Professor, Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch 6150, Australia. john.olynyk@health.wa.gov.au
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: May 2, 2021
Revised: May 14, 2021
Accepted: July 21, 2021
Article in press: July 21, 2021
Published online: August 7, 2021
Abstract

Chronic infections with the hepatitis B and C viruses have significant worldwide health and economic impacts. Previous treatments for hepatitis C such as interferon and ribavirin therapy were ineffective and poorly tolerated by patients. The introduction of directly acting curative antiviral therapy for hepatitis C and the wider use of nucleos(t)ide analogues for suppression of chronic Hepatitis B infection have resulted in many positive developments. Decreasing the prevalence of hepatitis B and C have concurrently reduced transmission rates and hence, the number of new infections. Antiviral treatments have decreased the rates of liver decompensation and as a result, lowered hospitalisation and mortality rates for both chronic hepatitis B and C infection. The quality of life of chronically infected patients has also been improved significantly by modern treatment. Antiviral therapy has stopped the progression of liver disease to cirrhosis in certain patient cohorts and prevented ongoing hepatocellular damage in patients with existing cirrhosis. Longer term benefits of antiviral therapy include a reduced risk of developing hepatocellular carcinoma and decreased number of patients requiring liver transplantation. This review article assesses the literature and summarises the impact of modern antiviral therapy of chronic hepatitis B and C on clinical outcomes from liver disease.

Keywords: Hepatitis B, Hepatitis C, Nucleotide analogues, Directly acting antiviral therapy, Clinical outcomes, Liver disease

Core Tip: Hepatitis B and C infection contribute significantly to the global burden of liver disease. With the introduction of modern antiviral therapy, there is now an effective curative treatment for hepatitis C and potent suppressive antiviral therapy for hepatitis B. Antiviral therapy has had a positive impact on liver disease by reducing hospitalisation rates and hence, cost to global health systems. Rates of decompensation, hepatocellular carcinoma and need for transplantation have all been lowered. This review article assesses the literature and summarises the impact of modern antiviral therapy of chronic hepatitis B and C on clinical outcomes from liver disease.