Benefits and risks of HCV cure
Authors:
T. Nesnídal 1,2; S. Fraňková 1
Authors‘ workplace:
Klinika hepatogastroenterologie IKEM, Praha
1; 3. lékařská fakulta UK, Praha
2
Published in:
Gastroent Hepatol 2026; 80(2): 98-103
Category:
Hepatology: Rewiev Article
doi:
https://doi.org/10.48095/ccgh202698
Overview
Chronic hepatitis C virus (HCV) infection remains a major cause of liver-related morbidity and mortality worldwide. The natural course of HCV infection is highly variable, ranging from asymptomatic disease to significant fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). The advent of direct-acting antivirals (DAAs) has revolutionized HCV treatment, achieving sustained virologic response (SVR) rates exceeding 95% across all stages of liver disease. Viral eradication is associated with reduced liver inflammation, regression of fibrosis, and reduced portal hypertension. More importantly, SVR significantly reduces the risk of liver decompensation, HCC, and liver disease-related mortality. However, the risk of HCC is not entirely eliminated, particularly in patients with advanced fibrosis or cirrhosis, and therefore, HCC surveillance is recommended. DAA therapy has also made it possible to treat patients with decompensated cirrhosis, leading to improved liver function, and in selected cases, removal of the patient from the liver transplant waiting list. However, treatment response and clinical course depend on baseline liver function; in patients with advanced disease (MELD score ≥ 20), the chance of achieving SVR is lower, with a higher risk of adverse events. Even after achieving SVR, metabolic risk factors, including obesity, diabetes, and fatty liver disease, may negatively impact further course of the disease and the risk of developing HCC. Weight gain after achieving SVR can be significant and influenced by host genetic factors, such as variants of the PNPLA3 gene.
Keywords:
HCV infection – cirrhosis – hepatocellular carcinoma – sustained virological response
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