Hepatitis C-related liver cirrhosis - strategies for the prevention of hepatic decompensation, hepatocarcinogenesis, and mortality

Table 1 Comparison of natural histories among patients with hepatitis B virus-related, hepatitis C virus-related, nonalcoholic steatohepatitis-related, and alcoholic compensated liver cirrhosis

Natural history	HCV	HBV	Alcoholic	NASH	Ref.
Hepatic decompensation	5.6%	3.2%			[5]
	5.6%		4.4%		[7]
	6.0%			4.5%	[11]
Hepatocarcinogenesis	2.0%	1.8%			[5]
	8.3%	3.3%			[6]
	4.7%		0.6%		[7]
	6.1%			2.3%	[12]
Mortality	3.2%	2.8%			[5]
	6.3%	3.6%			[6]
	5.1%		4.3%		[7]
	2.0%			0.4%	[11]
	5.2%			5.0%	[12]

All figures are expressed as average annual percentage rates. HBV: Hepatitis B virus; HCV: Hepatitis C virus; NASH: Nonalcoholic steatohepatitis; LC: Liver cirrhosis.

Table 2 Antiviral therapies for hepatitis C virus-related liver cirrhosis

Antiviral therapy	Number of treated patients	SVR rate	Decompensation1	HCC1	Mortality1	Severe AE rate2	Ref.
IFN-based therapy aiming at SVR
IFN monotherapy	271	15.1% for genotype 1; 47.2% for others		0.65 (0.31)	0.54 (0.05)		[32]
IFN + RBV	132	30.3% for genotype 1b; 80.0% for others		(0.28)		12.1%	[33]
Pegylated IFN + RBV	57	24.2% for genotype 1; 70.8% for others				10.5%	[26]
	87	20.5% for genotype 1/4; 72.1% for genotype 2/3				25.0%	[28]
	568	24.4% for genotype 1; 54.9% for others				29.6%	[36]
Pegylated IFN + RBV + boceprevir	39 (all genotype 1)	59.0%					[79]
Pegylated IFN + RBV + telaprevir	21 (all genotype 1)	61.9%					[24]
Pegylated IFN + RBV + simeprevir	83 (all genotype 1)	70%-73% for relapsers; 15%-82% for partial responders; 31%-46% for null responders					[82]
Pegylated IFN + RBV + mericitabine	21 (genotype 1/4)	38.1%					[83]
IFN-based therapy after treatment for HCC
IFN monotherapy	76 (pure HCV, 42)			0.303		0%	[74]
Pegylated IFN maintenance therapy	427			0.45			[57]
	311 (portal hypertension, 39)		0.254			17%	[56]
Faldaprevir + deleobuvir + RBV	34 (all genotype 1)	57% in patients treated thrice daily; 54% in patients treated twice daily					[85]

¹The relative risk reduction of clinical events is expressed as a hazard ratio: total cases (SVR cases);

²Severe AE rate is expressed as the rate of IFN discontinuation due to adverse events;

³HCC recurrence in adherent patients with pure HCV;

⁴Hepatic decompensation in patients with portal hypertension. HCV: Hepatitis C virus; SVR: Sustained virological response; HCC: Hepatocellular carcinoma; AE: Adverse event; IFN: Interferon; RBV: Ribavirin; DAA: Direct-acting antiviral agent.