Antiviral Therapy in Decompensated Hepatitis C Virus (HCV) Cirrhosis
Antiviral Therapy in Decompensated Hepatitis C Virus (HCV) Cirrhosis
To evaluate:

 1. the impact of combined antiviral therapy (Peginterferon plus ribavirin) on natural
 history of patients affected with HCV decompensated cirrhosis, after sustained
 virological response. A controlled study.

 2. safety and efficacy of antiviral therapy in this population by using a statistically
 significally number of patients as controls.
Decompensated HCV cirrhosis is a relevant problem as its clinical evidences predisposes to an
 high mortality risk, with a survival rate of 50% at 5 years (1,2). Davis et. al processed a
 mathematical model of the natural history of chronic hepatitis C and projected the total
 number of cases with cirrhosis increased by more than 50% by 2010 and then plateaued (3). As
 a result, there will be a dramatic increase in the number of cases with complications of
 liver failure and decompensated events of cirrhosis will increase to 25% in 2010, 32% in
 2020, 36% in 2030, and 38% in 2040 (3, table 1).Liver transplantation is the treatment of
 choice but the limited number of organ donor makes not realizable for the major of patients.
 Furthermore, age over 65 years correlated disease is not accepted to enter into the list of
 liver transplant. To prevent these patients from worsening their liver disease has positive
 economic implications in terms of health care resources used as diagnostic tests, clinic
 visits, drug therapy, hospitalization for management of complications, and later on, liver
 transplantation, and indirect costs related to lost work time and impaired quality of life.
 our controlled study on antiviral treatment of decompensated cirrhotics has shown that HCV
 clearance by therapy can be life-saving, improves hepatic function, and reduces disease
 progression. Treatment should be encouraged in CTP classes A and B, and especially in
 patients infected by genotype 2. The benefit of treating patients with genotype 1 remains
 unproven.
Inclusion Criteria: HCV cirrhotics admitted to hospital for a decompensated event, such as
 ascites, variceal bleeding, and hepatic encephalopathy -

 Exclusion Criteria: rapid deterioration of liver and/or renal function, detection of
 hepatocarcinoma, infection with HIV or HBV viruses, current alcohol or drug abuse, chronic
 invalidating disease, bacterial infections, platelets <35,000 cells/μL, neutrophils <1,000
 cells/μL, haemoglobin level <10 g/dL, total bilirubin >3 mg/dL, and serum creatinine >2.0
 mg/dL.

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