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Fibrosis reversal after hepatitis C virus elimination

Rockey, Don C.

Current Opinion in Gastroenterology: May 2019 - Volume 35 - Issue 3 - p 137–144
doi: 10.1097/MOG.0000000000000524
LIVER: Edited by Don C. Rockey
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Purpose of review Hepatitis C virus (HCV) infection has been the leading cause of cirrhosis in the United States now for the last several decades. With the introduction of highly effective direct acting antiviral (DAA) drugs, cure rates are now almost 100%. With this explosion of effective therapy, it is possible that many patients with HCV may have reversion in fibrosis. The purpose of this review is, therefore, to report on recent findings in this field.

Recent findings Older data that examined the effect of interferon-based HCV therapy indicate that fibrosis reverses after HCV eradication. More recent work in the DAA era similarly indicates that fibrosis is reversible. A caveat is that DAA therapy causes rapid viral clearance, and appears to lead to rapid reductions in inflammation. Some tools (such as transient elastography), which may also reflect the inflammatory response, and thus may ‘overestimate’ of fibrosis reversal. However, emerging data suggesting improved outcomes in patients with cirrhosis after HCV clearance support the concept that even cirrhosis reverses in some patients.

Summary Fibrosis (and cirrhosis) reversion, to some extent, occurs after HCV clearance. This topic is vitally important and information continues to emerge; more data on this subject are expected and needed.

Department of Internal Medicine, The Medical University of South Carolina, Charleston, USA

Correspondence to Don C. Rockey, MD, Professor and Chairman, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, 803 CSB, Charleston, SC 29425, USA. Tel: +1 843 792 2914; fax: +1 843 792 5265; e-mail: rockey@musc.edu

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