Impact of hepatitis C oral therapy in portal hypertension

Abstract

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

Impact of Sustained Virological Response for Gastroesophageal Varices in Hepatitis-C-Virus-Related Liver Cirrhosis

“…However, analyses of SVR after DAA treatment in LC patients with GEVs have not yet been fully performed and might provide further insights to help with the individualization of the treatment for LC patients. A point of no return might exist where HCV eradication is no longer capable of averting the progression of PH or liver decompensation [24]. In addition, data for the comparison of the impact of HCV eradication on GEVs progression among LC patients treated with IFN-based therapies or DAA-based therapies, and LC patients with non-SVR (persistent viremia) are currently scarce.…”

Variceal recurrence 4 years post endoscopic band ligation in hepatitis C patients who achieved sustained virological response with oral direct‐acting antiviral therapy

“…Link between achieving SVR and reduction in portal hypertension was examined in different studies. Libânio et al recommended that studies with long‐term follow‐up are needed to determine the actual effect of DAAs on portal hypertension with more focus on predictors of its resolution 23 . Regarding portal hypertension, SVR six months after interferon‐based therapy significantly associated with modest decline in hepatic venous pressure gradient (HVPG) in a study 24 .…”

“…14 This, coupled with high SVR levels and the high safety profile of DAAs, could change the history of HCV infection and improve clinical outcomes especially avoiding portal hypertension. It will also improve the condition of patients with established portal hypertension 23. Van der Meer AJ in 2015 deciphered the impact on further hepatitis C virus-related disease SVR following antiviral therapy.…”

The Matrisome, Inflammation, and Liver Disease

“…48,49 Moreover, vascular changes (e.g., portal hypertension) and other sequelae of severe/decompensated cirrhosis do not appear to as readily reverse even after SVR. 50 Globally, over 1 million people die from complications of cirrhosis each year, and an estimated 1 million more people die from related diseases (e.g., hepatocellular carcinoma). 51 Despite a clear understanding of disease progression, there is no universally accepted therapy available to halt or reverse this process in humans.…”