Lynch Erica Nicola, Russo Francesco Paolo
Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padova, Italy.
Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy.
J Clin Med. 2023 Mar 12;12(6):2195. doi: 10.3390/jcm12062195.
Treatment of hepatitis C (HCV) has been revolutionized with the introduction of direct-acting antivirals (DAAs). Patients can be treated at more advanced stages of liver disease, with a growing number of cirrhotic patients achieving sustained virological response (SVR). Long-term outcomes for cured patients and the optimal follow-up care of patients after SVR are yet to be defined, because most studies on cirrhotic patients cured with DAAs have a short follow-up period. There are many open questions related to patient management after viral eradication with DAAs, such as which could be the most reliable non-invasive tool to predict liver-related complications, or to what extent viral eradication reduces the risk of liver disease progression in the long term. Growing evidence supports the personalization of follow-up care based on individual risk. The aim of this narrative review is to analyze the impact of viral eradication with DAAs on clinically significant portal hypertension, hepatocellular carcinoma, and extrahepatic manifestations, as well as to summarize indications for optimal follow-up care of HCV patients treated with DAAs.
直接作用抗病毒药物（DAAs）的引入彻底改变了丙型肝炎（HCV）的治疗方式。患者可以在肝病的更晚期接受治疗，越来越多的肝硬化患者实现了持续病毒学应答（SVR）。治愈患者的长期预后以及SVR后患者的最佳随访护理尚未明确，因为大多数关于用DAAs治愈的肝硬化患者的研究随访期较短。在用DAAs根除病毒后，与患者管理相关的许多问题仍未解决，例如哪种可能是预测肝脏相关并发症最可靠的非侵入性工具，或者病毒根除在长期内可将肝病进展风险降低到何种程度。越来越多的证据支持基于个体风险的随访护理个性化。本叙述性综述的目的是分析用DAAs根除病毒对具有临床意义的门静脉高压、肝细胞癌和肝外表现的影响，以及总结接受DAAs治疗的HCV患者最佳随访护理的指征。
