Decompensation in Direct-Acting Antiviral Cured Hepatitis C Virus Compensated Patients With Clinically Significant Portal Hypertension: Too Rare to Warrant Universal Β-Blocker Therapy

• Published in: The American journal of gastroenterology Vol. 116; no. 6; pp. 1342 - 1344
• Main Authors: Tosetti, Giulia, Degasperi, Elisabetta, Farina, Elisa, D'Ambrosio, Roberta, Soffredini, Roberta, Borghi, Marta, La Mura, Vincenzo, Primignani, Massimo, Lampertico, Pietro
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer 01.06.2021; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Alcohol use; Antiviral drugs; Ascites; Clinical significance; Confidence intervals; Gastroenterology; Grants; Hepatitis C; Hypertension; Liver; Liver cancer
• ISSN: 0002-9270; 1572-0241; 1572-0241
• DOI: 10.14309/ajg.0000000000001158

Nonselective β-blockers improve decompensation-free survival in viremic hepatitis C virus compensated cirrhotic patients with clinically significant portal hypertension, but their protective role after sustained virological response by direct-acting antiviral (DAA) is undefined. We evaluated the incidence of decompensation in DAA-cured Child-A patients without high-risk varices. During the 49-month (12–60) follow-up, only one of 148 patients decompensated (ascites), with a 4-year cumulative risk of 1%, but decompensation was associated with hepatocellular carcinoma. The risk of decompensation in DAA cured hepatitis C virus compensated Child-A cirrhotic patients with clinically significant portal hypertension but without high-risk varices is negligible; thus, questioning the need for nonselective β-blocker treatment in this setting (see Visual abstract, Supplemental Digital Content, 1, http://links.lww.com/AJG/B861). JOURNAL/ajgast/04.03/00000434-202106000-00035/inline-graphic1/v/2021-05-27T224554Z/r/image-tiff