Published online Mar 8, 2017. doi: 10.4254/wjh.v9.i7.352
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
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.
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.