Treatment of hepatitis C in the patient with decompensated cirrhosis.

Current estimates indicate that 212,500 Americans have cirrhosis caused by hepatitis C and by the year 2015 this number will increase to more than 375,000. Worldwide, respective estimates are 7.8 and 13.8 million. Given this emerging problem, clinical investigators are examining the role of antiviral therapy for patients with chronic hepatitis C who have cirrhosis, especially with decompensated disease. Genotype and the ability to tolerate the full dose and duration of therapy are major predictors of virologic response. Combined results from 4 studies using different antiviral regimens indicated that 22 of 99 patients (23%) treated before liver transplantation remained free of hepatitis C posttransplant. Significant side effects and serious adverse events may complicate antiviral therapy in patients with advanced liver disease. Carefully controlled trials are needed to expand on these observations.