eViralHepatitis Review

HCV Cure: Impact on Hepatic and Nonhepatic Outcomes

In this issue:

Well-tolerated direct-acting antiviral medications (DAAs) can achieve sustained virological response (SVR) in at least 95% of all patient populations infected with the hepatitis C virus. But what does “curing” HCV mean for both liver and nonliver HCV-related complications?

To what degree is long-term HCV-related liver damage ameliorated by SVR? How can cirrhosis, liver failure, and HCC be best avoided (or managed) in formerly infected patients? If, as the evidence strongly suggests, conditions like insulin resistance, type 2 diabetes, cardiovascular disease, and cryoglobulinemia are directly related to active HCV infection, what are the effects of achieving SVR?

In this issue, Drs. Jordan Feld and Lisette Krassenburg from the Toronto Centre for Liver Disease at the University of Toronto analyze the evidence on how HCV cure can impact the outcomes of hepatic and nonhepatic HCV complications.

Learning objectives:

• Summarize the benefits and limitations of achieving SVR on liver-related complications such as hepatic decompensation and HCC.
• Describe how cure of HCV infection may reduce the risk of nonhepatic complications such as diabetes and heart disease.
• Explain why patients with cirrhosis prior to successful HCV treatment remain at risk of developing HCC and require ongoing surveillance.