Antiviral Therapy for Hepatitis C Virus Infection in Cirrhosis

The advent of direct-acting antivirals (DAAs) has made a cure for hepatitis C virus (HCV) a reality, while the WHO has set a goal of eliminating HCV worldwide by 2030. DAA-based interferon-free therapies for chronic hepatitis C are highly effective, achieving a more than 90% sustained virologic response (SVR) including patients with advanced chronic liver disease. Studies have demonstrated that elimination of HCV improves the prognosis of patients with cirrhosis, reduces the risk of liver decompensation, and reduces, but does not completely eliminate, the risk of hepatocellular carcinoma (HCC). Based on the current guidelines, this paper discussed the goal, indication, assessment before treatment, and endpoint of antiviral therapy for patients with cirrhosis and HCV infection. We also discussed the treatment for special population of patients with cirrhosis, including children and adolescents, patients with renal insufficiency, coinfection with human immunodeficiency virus or hepatitis B virus, or patients with HCC. Finally, the monitoring strategy of cirrhotic patients during DAA treatment and after SVR was presented.