Hepatitis C Treatment: Direct-Acting Antivirals, Sofosbuvir, Ribavirin, and Long-Term Liver Follow-Up for Sustained Virologic Response

Dear colleagues, the treatment of hepatitis C has undergone a revolution in recent years due to the introduction of direct-acting antivirals (DAA). These medications have transformed the management of this disease, allowing for sustained virologic response (SVR) rates exceeding 95% in most patients. However, access to these hepatitis C treatments remains a challenge in many regions, and the long-term follow-up of cured patients raises new questions regarding the management of liver complications.

Diving Deeper into Direct-Acting Antiviral Treatment

DAAs, such as sofosbuvir, have proven to be highly effective and safe, enabling treatment for patients in advanced stages of liver disease, including those with decompensated cirrhosis. The combination of DAAs with ribavirin remains relevant in certain cases, particularly in patients with genotype 3 of the virus or with resistance-associated variants [1].

The impact of viral eradication with DAAs on the improvement of liver fibrosis is significant. Recent studies have shown a decrease in the FIB-4 index, indicating an improvement in liver fibrosis both in the short and long term [2]. However, continuous monitoring is crucial, as the eradication of the virus does not completely eliminate the risk of liver complications, such as hepatocellular carcinoma [3].

Additionally, co-infection with the hepatitis B virus (HBV) in patients treated with DAAs for hepatitis C requires special attention. Although HBV reactivation is rare, cases have been documented, underscoring the importance of careful follow-up [4].

Conclusions

The treatment of hepatitis C with direct-acting antivirals has marked a milestone in modern medicine, offering an effective cure for a disease that was previously difficult to treat. Nevertheless, long-term follow-up of cured patients is essential to adequately manage liver complications and optimize health outcomes. Ongoing research and equitable access to these treatments are fundamental to achieving global hepatitis C elimination goals.

Referencias

• [1] Peginterferon alfa-2a for the treatment of chronic hepatitis C in the era of direct-acting antivirals.
• [2] Evaluating short-term and long-term liver fibrosis improvement in hepatitis C patients post-DAA treatment.
• [3] Impact of direct acting antivirals on occurrence and recurrence of hepatocellular carcinoma: Biologically plausible or an epiphenomenon?.
• [4] Hepatitis B virus coinfection in patients treated for chronic hepatitis C: clinical characteristics, risk of reactivation with long-term follow-up, and effectiveness of antiviral therapy.

Created 4/1/2025