Management of HCV-related decompensated cirrhosis with direct-acting antiviral agents: who should be treated?

Background Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV genotype 4-related decompensated cirrhosis. Methods The study included a treatment group ( n = 160) composed of HCV patients with decompensated cirrhosis who received DAAs for 3 months and a matched control group ( n = 80) who preferred not to receive DAAs, follow-up was for 24–31 months. Results In treatment group; there were improvements in platelet count, albumin, CTP ( p = 0.001) and MELD scores ( p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular carcinoma (HCC) developed in 10% ( n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs. the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%. Conclusion HCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD and survival. Clinical trial: (NCT03547895).