Hepatitis C And Cirrhosis

Chronic HCV is not the only cause of cirrhosis. There are a lot many reasons for this infectious liver disease.

Other conditions like alcoholism, autoimmune disorders, Hepatitis B and other causes can also lead to cirrhosis. In HCV, there is a gradual formation of the scar tissue on the liver because of the attack of the virus. Early damage is called fibrosis and severe is called cirrhosis.

Over a period of 20-30 years of the infection, about 5-20% people develop cirrhosis.

Cirrhosis is irreversible usually but reversal was observed in almost half of the people infected otherwise liver transplant is the only option available.
There are two stages of cirrhosis – compensated and decompensated.

The first one means that the liver is still functioning pretty well. Early symptoms may still be unclear, and some people may still be unaware that they have cirrhosis.

Symptoms of compensated cirrhosis include:

  • Loss of appetite
  • Confusion
  • Dark coloured urine
  • Easy bruising, abnormal urine
  • Edema
  • Fatigue
  • Impotence
  • Itchy skin
  • Jaundice
  • Nausea
  • Pale coloured stool
  • Redness on the palm of hands
  • Spider veins
  • Weight loss

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Decompensated cirrhosis indicates that the liver is not functioning well. A few serious complications can happen during this.

  • Ascites – fluid accumulation in the abdomen
  • Hepatic encephalopathy (HE) – a brain disorder that develops because the liver is unable to remove ammonia and other toxins from the body. It can lead to impaired concentration, sleep disturbances etc.
  • Spontaneous bacterial peritonitis (SBP) is an infection that is caused in the membranes that cover the abdominal organs.
  • Variceal hemorrhage – severe bleeding from the enlarged veins in the esophagus and upper stomach.

The level of cirrhosis is measured in terms of the Child-Pugh or Child-Turcotte-Pugh (CTP) score. CTP Class A is the least amount of damage from cirrhosis and is considered compensated. CTP Class B and C are decompensated cirrhosis, with Class C being the most severe.

AASLD HCV Treatment Recommendations* for People with Decompensated Cirrhosis (CTP Class B or C)

Recommended

Alternative

Genotype 1
-treatment-naive and -experienced


  • Daklinza + Sovaldi + low initial dose ribavirin for 12 weeks
  • Epclusa + ribavirin for 12 weeks
  • Harvoni + low initial dose of ribavirin for 12 weeksexperienced

For those inelgible to take ribavirin:

  • Daklinza + Sovaldi for 24 weeks
  • Epclusa for 24 weeks
  • Harvoni for 24 weeks

Genotype 1
-who failed prior Sovaldi-based regimen


  • Epclusa + ribavirin for 24 weeks
  • Harvoni + low initial dose of ribavirin for 24 weeks

n/a

Genotype 2
-treatment-naive and -experienced


  • Daklinza + Sovaldi + low initial dose ribavirin for 12 weeks
  • Epclusa + ribavirin for 12 weeks

n/a

Genotype 3

-treatment-naive and -experienced


  • Daklinza + Sovaldi + low initial dose ribavirin for 12 weeks
  • Epclusa + ribavirin for 12 weeks

n/a

Genotype 4

-treatment-naive and -experienced


  • Daklinza + Sovaldi + low initial dose ribavirin for 12 weeks
  • Epclusa + ribavirin for 12 weeks
  • Harvoni + low initial dose of ribavirin for 12 weeks

For those inelgible to take ribavirin:

  • Daklinza + Sovaldi for 24 weeks
  • Epclusa for 24 weeks
  • Harvoni for 24 weeks

Genotype 4

-treatment-experienced who failed prior

Sovaldi-based regimen


  • Epclusa + ribavirin for 12 weeks
  • Harvoni + low initial dose of ribavirin for 24 weeks

n/a

Genotype 5


n/a

n/a

Genotype 6

n/a

n/a


* When more than one treatment is recommended, medications are listed alphabetically

Medications that are NOT recommended for people with decompensated cirrhosis:

  • Regimens containing peginterferon
  • Monotherapy with peginterferon, ribavirin or a direct-acting antiviral
  • Regimens using Incivek, Olysio, Technivie, Victrelis, Viekira, or Zepatier
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