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"Antivirals"

Special Issue

2025 KASL clinical practice guidelines for management of hepatitis C
Eun Sun Jang, Nae Yun Heo, Jae Yoon Jeong, Jung Gil Park, Do Seon Song, Eun Ju Cho, Chang Hun Lee, Jae Seung Lee, Jae Hyun Yoon, Seul Ki Han, Young Kul Jung, on behalf of the Korean Association for the Study of the Liver (KASL)
Clin Mol Hepatol 2026;32(1):1-52.
Published online October 23, 2025
DOI: https://doi.org/10.3350/cmh.2025.0777
  • 1,720 View
  • 198 Download

Correspondences

Emerging evidence supports direct-acting antiviral therapy for HCC patients beyond the early stage: Correspondence to editorial on “Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: A nationwide cohort study”
Teng-Yu Lee, Pei-Chien Tsai, Shou-Wu Lee, Ming-Lung Yu
Clin Mol Hepatol 2026;32(1):e68-e71.
Published online March 4, 2025
DOI: https://doi.org/10.3350/cmh.2025.0235

Citations

Citations to this article as recorded by  Crossref logo
  • Revisiting unmet needs in clinical research on direct-acting antiviral therapy for HCC patients: Correspondence to letter to the editor on “Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: A nationwide cohort study”
    Teng-Yu Lee, Pei-Chien Tsai, Shou-Wu Lee, Ming- Lung Yu
    Clinical and Molecular Hepatology.2026; 32(1): e99.     CrossRef
  • Should direct-acting antiviral be considered for all patients with HCV-related hepatocellular carcinoma?: Reply to correspondence on “Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: A nationwide cohort study”
    Yan Ling Ong, Apichat Kaewdech, Yu Jun Wong
    Clinical and Molecular Hepatology.2026; 32(1): e109.     CrossRef
  • 4,730 View
  • 38 Download
  • 1 Web of Science
  • Crossref

Viral hepatitis

Correspondence to editorial on “Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C”
Tom Ryu, Young Chang, Seung Up Kim, Jae Young Jang
Clin Mol Hepatol 2025;31(2):e203-e205.
Published online February 24, 2025
DOI: https://doi.org/10.3350/cmh.2025.0179

Citations

Citations to this article as recorded by  Crossref logo
  • Reply to correspondence on “Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C”
    Chen-Hua Liu, Yu-Ping Chang
    Clinical and Molecular Hepatology.2025; 31(2): e232.     CrossRef
  • 4,853 View
  • 25 Download
  • 1 Web of Science
  • Crossref

Original Articles

Direct-acting antiviral therapy for patients with hepatitis C virus-related hepatocellular carcinoma: A nationwide cohort study
Shou-Wu Lee, Sheng-Shun Yang, Pei-Chien Tsai, Chung-Feng Huang, Chi-Yi Chen, Chao-Hung Hung, Chien-Hung Chen, Chi-Ming Tai, Pin-Nan Cheng, Hsing-Tao Kuo, Kuo-Chih Tseng, Lein-Ray Mo, Ching-Chu Lo, Yi-Hsiang Huang, Han-Chieh Lin, Pei-Lun Lee, Ming-Jong Bair, Te-Sheng Chang, Chun-Yen Lin, Szu-Jen Wang, Tsai-Yuan Hsieh, Tzeng-Hue Yang, Cheng-Yuan Peng, Chi-Chieh Yang, Lee-Won Chong, Chien-Wei Huang, Chih-Wen Lin, Cheng-Hsin Chu, Ming-Chang Tsai, Jia-Horng Kao, Chun-Jen Liu, Wan-Long Chuang, Teng-Yu Lee, Ming-Lung Yu, on behalf of TACR investigators
Clin Mol Hepatol 2025;31(3):899-913.
Published online February 5, 2025
DOI: https://doi.org/10.3350/cmh.2024.1015
Background/Aims
The survival benefit of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection in patients with hepatocellular carcinoma (HCC), particularly in Barcelona Clinic Liver Cancer (BCLC) stages B/C, remains largely uncertain. We aimed to explore the impact of DAA therapy on overall survival (OS) in HCC patients using a nationwide cohort study.
Methods
We utilized the nationwide Taiwan Association for the Study of the Liver (TASL) HCV Registry (TACR) database to include all adults receiving a DAA therapy for HCV, excluding those with other viral infections, liver transplantation, non-HCC malignancies, and terminal-staged HCC. We respectively analyzed the adjusted odds ratio (aOR) for sustained virological response (SVR) and adjusted hazard ratio (aHR) for OS.
Result
s: Between December 2013 and December 2020, 2,205 (9.3%) patients with HCC and 21,569 (90.7%) patients without HCC were include. The SVR rates were 96.6% in the HCC group and 98.8% in the non-HCC group (P<0.001), with HCC being an independent risk factor affecting SVR (aOR 0.41; 95% CI 0.31–0.54; P<0.001). In the whole patient cohort, SVR was independently associated with improved OS (aHR 0.46; 95% CI 0.35–0.60; P<0.001). Among patients with baseline HCC, SVR remained an independent factor related to OS (aHR 0.41; 95% CI 0.28–0.59; P<0.001). The impact of SVR on OS persisted significantly across BCLC stages 0/A and stages B/C.
Conclusions
High SVR rates among HCC patients underscore the importance of DAA therapy in enhancing OS, reaffirming its efficacy across various HCC stages.

Citations

Citations to this article as recorded by  Crossref logo
  • Revisiting unmet needs in clinical research on direct-acting antiviral therapy for HCC patients: Correspondence to letter to the editor on “Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: A nationwide cohort study”
    Teng-Yu Lee, Pei-Chien Tsai, Shou-Wu Lee, Ming- Lung Yu
    Clinical and Molecular Hepatology.2026; 32(1): e99.     CrossRef
  • Emerging evidence supports direct-acting antiviral therapy for HCC patients beyond the early stage: Correspondence to editorial on “Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: A nationwide cohort study”
    Teng-Yu Lee, Pei-Chien Tsai, Shou-Wu Lee, Ming-Lung Yu
    Clinical and Molecular Hepatology.2026; 32(1): e68.     CrossRef
  • Survival impact of hepatitis C virus eradication in patients with or without active hepatocellular carcinoma: A nationwide cohort study
    Teng-Yu Lee, Sheng-Shun Yang, Pei-Chien Tsai, Chung-Feng Huang, Chi-Yi Chen, Chao-Hung Hung, Chien-Hung Chen, Chi-Ming Tai, Pin-Nan Cheng, Hsing-Tao Kuo, Kuo-Chih Tseng, Lein-Ray Mo, Ching-Chu Lo, Yi-Hsiang Huang, Han-Chieh Lin, Pei-Lun Lee, Ming-Jong Bai
    European Journal of Cancer.2026; 232: 116109.     CrossRef
  • Letter to the editor on “Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: a nationwide cohort study”
    Qiong Wang, Zhongqing Qian, Xiaodi Yang, Deyan Chen, Xiaojing Wang, Fuliang Chen
    Clinical and Molecular Hepatology.2026; 32(1): e7.     CrossRef
  • Setting the Record Straight: Utility and Outcomes in Patients With HCV Related HCC
    María Fernanda Guerra‐Veloz, Sital Shah, Beatrice Emmanouil, Mia Olsen, Renita George, Sarah Selemani, Paul J. Ross, Ivana Carey, Neha Mehta, Mark Gillyon‐Powell, Kosh Agarwal
    Journal of Viral Hepatitis.2026;[Epub]     CrossRef
  • HIV, Viral Hepatitis, and Schistosomiasis Association with Liver Cancer: A Systematic Review
    Khumbuzile Canham, Pragalathan Naidoo, Sibusiso Senzani, Sayed Shakeel Kader, Zilungile L. Mkhize-Kwitshana
    Microorganisms.2025; 13(12): 2753.     CrossRef
  • 12,676 View
  • 215 Download
  • 8 Web of Science
  • Crossref

Viral hepatitis

Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C
Tom Ryu, Young Chang, Soung Won Jeong, Jeong-Ju Yoo, Sae Hwan Lee, Sang Gyune Kim, Young Seok Kim, Hong Soo Kim, Seung Up Kim, Jae Young Jang
Clin Mol Hepatol 2025;31(2):548-562.
Published online January 9, 2025
DOI: https://doi.org/10.3350/cmh.2024.0904
Background/Aims
Direct-acting antivirals (DAAs) effectively eradicate hepatitis C virus. This study investigated whether metabolic dysfunction influences the likelihood of fibrosis regression after DAA treatment in patients with chronic hepatitis C (CHC).
Methods
This multicenter, retrospective study included 8,819 patients diagnosed with CHC who were treated with DAAs and achieved a sustained virological response (SVR) between January 2014 and December 2022. Fibrosis regression was defined as a 20% reduction in noninvasive surrogates for liver fibrosis, such as liver stiffness (LS) measured by vibration-controlled transient elastography (VCTE) and the fibrosis-4 (FIB-4) score. Hypercholesterolemia (h-TC) was defined as >200 mg/dL.
Result
s: The median age of the study population was 59.6 years, with a predominance of male patients (n=4,713, 57.3%). Genotypes 1, 2, and others were confirmed in 3,872 (46.2%), 3,487 (41.6%), and 1,024 (12.2%) patients, respectively. Diabetes mellitus (DM) was present in 1,442 (17.2%) patients and the median LS was 7.50 kPa (interquartile range, 5.30–12.50). Multivariate analysis revealed that the presence of DM and pre-DAA h-TC were independently associated with a decreased probability of fibrosis regression by VCTE. Additionally, pre-DAA h-TC was independently associated with a decreased probability of fibrosis regression by the FIB-4.
Conclusions
Metabolic dysfunction has an unfavorable influence on fibrosis regression in patients with CHC who achieve SVR after DAA treatment.

Citations

Citations to this article as recorded by  Crossref logo
  • Editorial: Risk of Incident Type 2 Diabetes and Prediabetes in Patients With Direct Acting Antiviral‐Induced Cure of Hepatitis C Virus Infection—Authors' Reply
    Yu‐Ping Chang, Jia‐Horng Kao, Chen‐Hua Liu
    Alimentary Pharmacology & Therapeutics.2025; 61(9): 1553.     CrossRef
  • Epidemiologic Characteristics of Chronic Hepatitis B and Coinfections with Hepatitis C Virus or Human Immunodeficiency Virus in South Korea: A Nationwide Claims-Based Study Using the Korean Health Insurance Review and Assessment Service Database
    Hyunwoo Oh, Won Sohn, Na Ryung Choi, Hyo Young Lee, Yeonjae Kim, Seung Woo Nam, Jae Yoon Jeong
    Pathogens.2025; 14(7): 715.     CrossRef
  • 9,318 View
  • 153 Download
  • 6 Web of Science
  • Crossref

Reviews

Viral hepatitis

Unmet needs of chronic hepatitis C in the era of direct-acting antiviral therapy
Chung-Feng Huang, Ming-Lung Yu
Clin Mol Hepatol 2020;26(3):251-260.
Published online March 19, 2020
DOI: https://doi.org/10.3350/cmh.2020.0018
The treatment of chronic hepatitis C (CHC) has been revolutionized in an era of all-oral direct-acting antivirals (DAAs) since 2014. Satisfactory treatment efficacy and tolerability can be provided by novel DAAs. Nevertheless, there are still some unmet needs and emerging issues in the treatment of CHC in the DAA era. Certain hard-to-cure populations are prone to have inferior treatment responses, including patients with severe liver decompensation, active hepatocellular carcinoma (HCC), and hepatitis C virus (HCV) genotype 3 (HCV-3) infection and those who experience multiple DAA treatment failures. Hepatitis B virus (HBV) reactivation during and after DAA treatment has raised concern regarding the use of prophylactic antivirals against HBV throughout DAA treatment. However, the standard strategy for the use of prophylactic antivirals is not uniform across regional guidelines. In the post-sustained virological response (SVR) period, HCC still occurs in a substantial proportion of patients. Due to the relatively short follow-up period, the net benefit of the achievement of an SVR by DAAs in the reduction of extrahepatic manifestations has not yet been determined. Attention must also be paid to HCV reinfection, particularly in high-risk populations. The most critical and unmet need for HCV elimination is the large gap in the HCV care cascade at the population level. To accomplish the World Health Organization (WHO)’s goal for HCV elimination by 2030, the expansion of access to HCV care requires a continuous effort to overcome practical and political challenges.

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    The Kaohsiung Journal of Medical Sciences.2025;[Epub]     CrossRef
  • Long-Term Risk of Hepatic and Extrahepatic-Related Events After Direct Antiviral Therapy for Chronic Hepatitis C: A Prospective Long-Term Study Cohort
    Luisa Cavalletto, Eleonora Bertoli, Claudia Mescoli, Camillo Aliberti, Maria Giovanna Quaranta, Loreta Kondili, Liliana Chemello
    Cancers.2025; 17(9): 1528.     CrossRef
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    The Kaohsiung Journal of Medical Sciences.2025;[Epub]     CrossRef
  • HCV Genotype Distribution and Molecular Characteristics of HCV Core Domain I in Persons Living with HIV and HCV from Yunnan Province, China
    Yantao Zhu, Junyi Liu, Lijuan Kang, Fangchao Ruan, Jianjian Li, Nian Zhang, Yanling Chen, Zhiying Yao, Haihua Yang, Jun Leng, Jinglin Wang, Jiali Wang
    AIDS Research and Human Retroviruses.2025;[Epub]     CrossRef
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    Moon Haeng Hur, Jeong-Hoon Lee
    Clinical and Molecular Hepatology.2024; 30(2): 147.     CrossRef
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    Advances in Digestive Medicine.2024; 11(4): 189.     CrossRef
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    Marie T. Leibenguth, Jean T. Coulibaly, Kigbafori D. Silué, Yves K. N’Gbesso, Ahmed Abd El Wahed, Jürg Utzinger, Sören L. Becker, Sophie Schneitler, Alessandra Morassutti
    PLOS Neglected Tropical Diseases.2024; 18(6): e0012262.     CrossRef
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    Thong Duy Vo, Van Thi Thu Bui, Huong Tu Lam, Quynh Thi Huong Bui
    Pharmacology Research & Perspectives.2024;[Epub]     CrossRef
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    The Kaohsiung Journal of Medical Sciences.2024; 40(11): 962.     CrossRef
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    Carlo Smirne, Maria Grazia Crobu, Irene Landi, Nicole Vercellino, Daria Apostolo, David James Pinato, Federica Vincenzi, Rosalba Minisini, Stelvio Tonello, Davide D’Onghia, Antonio Ottobrelli, Silvia Martini, Christian Bracco, Luigi Maria Fenoglio, Mauro
    Viruses.2024; 16(12): 1899.     CrossRef
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    Nucleosides, Nucleotides & Nucleic Acids.2023; 42(4): 317.     CrossRef
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    Journal of Microbiology, Immunology and Infection.2023; 56(4): 680.     CrossRef
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    Vincenzo Savarino, Elisa Marabotto, Patrizia Zentilin, Manuele Furnari, Giorgia Bodini, Edoardo Giovanni Giannini, Edoardo Vincenzo Savarino
    Frontiers in Drug Safety and Regulation.2023;[Epub]     CrossRef
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    Journal of Microbiology, Immunology and Infection.2023; 56(3): 586.     CrossRef
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    Biology.2023; 12(6): 792.     CrossRef
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    Journal of Medical Education and Curricular Development.2023;[Epub]     CrossRef
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    Naim Abu-Freha, Osama Abu-Kosh, David Yardeni, Yaffa Ashur, Muhammad Abu-Arar, Baha Yousef, Shulamit Monitin, Sarah Weissmann, Ohad Etzion
    Life.2023; 13(9): 1872.     CrossRef
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    Clinical and Molecular Hepatology.2023; 30(1): 64.     CrossRef
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    Cancer Medicine.2022; 11(1): 104.     CrossRef
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    Shannon J Brown, Linh T Cosgrove, Samuel S Lee
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    Liver International.2021; 41(6): 1265.     CrossRef
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    Jae Seung Lee, Hong Jun Choi, Hye Won Lee, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Seung Up Kim
    Journal of Gastroenterology and Hepatology.2021; 36(9): 2479.     CrossRef
  • Long-term outcome of liver complications in patients with chronic HBV/HCV co-infection after antiviral therapy: a real-world nationwide study on Taiwanese Chronic Hepatitis C Cohort (T-COACH)
    Ming-Lun Yeh, Chao-Hung Hung, Kuo-Chih Tseng, Hsueh-Chou Lai, Chi-Yi Chen, Hsing-Tao Kuo, Jing-Houng Wang, Jyh-Jou Chen, Pei-Lun Lee, Rong-Nan Chien, Chi-Chieh Yang, Gin-Ho Lo, Chi‐Ming Tai, Chih-Wen Lin, Jia-Horng Kao, Chen-Hua Liu, Sheng-Lei Yan, Ming-J
    Hepatology International.2021; 15(5): 1109.     CrossRef
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    Vaia Valiakou, Petros Eliadis, Eirini Karamichali, Ourania Tsitsilonis, John Koskinas, Urania Georgopoulou, Pelagia Foka
    International Journal of Molecular Sciences.2021; 22(15): 7961.     CrossRef
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    Hung-Yin Liu, Yi-Hung Lin, Pei-Ju Lin, Pei-Chien Tsai, Shu-Fen Liu, Ying-Chou Huang, Jia-Jiun Tsai, Ching-I Huang, Ming-Lun Yeh, Po-Cheng Liang, Zu-Yau Lin, Chia-Yen Dai, Jee-Fu Huang, Wan-Long Chuang, Chung-Feng Huang, Ming-Lung Yu, Tatsuo Kanda
    PLOS ONE.2021; 16(7): e0254028.     CrossRef
  • In the era of rapid mRNA-based vaccines: Why is there no effective hepatitis C virus vaccine yet?
    Natalia Echeverría, Victoria Comas, Fabián Aldunate, Paula Perbolianachis, Pilar Moreno, Juan Cristina
    World Journal of Hepatology.2021; 13(10): 1234.     CrossRef
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Viral hepatitis

Upcoming direct acting antivirals for hepatitis C patients with a prior treatment failure
Tommaso Lorenzo Parigi, Maria Corina Plaz Torres, Alessio Aghemo
Clin Mol Hepatol 2019;25(4):360-365.
Published online May 2, 2019
DOI: https://doi.org/10.3350/cmh.2019.0022
Despite the high efficacy of direct acting antivirals (DAAs) not all patients successfully clear hepatitis C virus infection, in fact, approximately 1–3% fail to reach a sustained virological response 12 weeks after end of treatment. DAA failures are characterized by advanced liver disease, specific genotypes/subtypes and resistance associated substitutions to the DAA class they have been treated with. Current European Association for the Study of the Liver guidelines recommend three therapeutic options for such patients. The first is a 12 week course of sofosbuvir (SOF), velpatasvir (VEL) and voxilaprevir (VOX), which has shown to be effective in 90–99% of patients and was granted A1 level recommendation. The second option, reserved for patients who have predictors of failure consists in 12 weeks regimen with glecaprevir (GLE) and pibrentasvir (PIB), effective in 90–97%. Finally, although not supported by published data, for especially difficult to treat patients there should theoretically be a benefit in prolonged combinations of SOF+GLE/PIB or SOF/VEL/VOX±ribavirin. This review presents the latest evidence from both clinical trials and real-life on such therapeutic strategies.

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Viral hepatitis

Discussion on critical points for a tailored therapy to cure hepatitis C virus infection
Nadia Marascio, Angela Quirino, Giorgio Settimo Barreca, Luisa Galati, Chiara Costa, Vincenzo Pisani, Maria Mazzitelli, Giovanni Matera, Maria Carla Liberto, Alfredo Focà, Carlo Torti
Clin Mol Hepatol 2019;25(1):30-36.
Published online January 23, 2019
DOI: https://doi.org/10.3350/cmh.2018.0061
Hepatitis C virus (HCV) infects around 71 million people worldwide and in 2018 it is still a major health problem. Since 2011, anti-HCV therapy with availability of direct-acting antiviral drugs has revolutionized the clinical response and paved the way to eradication strategies. However, despite the high rate of sustained virological response, treatment failure may occur in a limited percentage of patients, possibly due to resistance-associated substitutions (RASs), either emergent or pre-existent even in minority viral populations. Clearly this problem may impair success of eradication strategies. With this background, several questions marks still exist around HCV treatment, including whether pan-genotypic treatments with complete effectiveness in any clinical conditions really exist outside clinical trials, the actual cost-effectiveness of genotyping testing, and utility of RAS detection in viral quasispecies by next generation sequencing approach. In this review, we describe these critical points by discussing recent literature data and our research experience.

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Viral hepatitis

2017 KASL clinical practice guidelines management of hepatitis C: Treatment of chronic hepatitis C
The Korean Association for the Study of the Liver (KASL)
Clin Mol Hepatol 2018;24(3):169-229.
Published online August 10, 2018
DOI: https://doi.org/10.3350/cmh.2018.1004

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    Eun Sun Jang, Kyung-Ah Kim, Young Seok Kim, In Hee Kim, Byung Seok Lee, Youn Jae Lee, Woo Jin Chung, Sook-Hyang Jeong
    Gut and Liver.2020; 14(6): 775.     CrossRef
  • A case report of glecaprevir/pibrentasvir-induced severe hyperbilirubinemia in a patient with compensated liver cirrhosis
    Jae Hyun Yoon, Sun Min Kim, Gaeun Kang, Hee Joon Kim, Chung Hwan Jun, Sung Kyu Choi
    Medicine.2019; 98(39): e17343.     CrossRef
  • The Efficacy and Safety of Direct-acting Antiviral Treatment for Chronic Hepatitis C Patients: A Single Center Study
    Seong Jun Park, Ah Ran Kim, Won Hyeok Choe, Jeong Han Kim, Byung Chul Yoo, So Young Kwon
    The Korean Journal of Gastroenterology.2018; 72(4): 197.     CrossRef
  • 20,940 View
  • 240 Download
  • 26 Web of Science
  • Crossref

Original Article

Viral hepatitis

Evolution of glomerular filtration rates and neutrophil gelatinase-associated lipocalin during treatment with direct acting antivirals
Alessio Strazzulla, Giuseppe Coppolino, Giorgio Settimo Barreca, Innocenza Gentile, Laura Rivoli, Maria Concetta Postorino, Maria Mazzitelli, Giuseppe Greco, Chiara Costa, Vincenzo Pisani, Nadia Marascio, Mariadelina Simeoni, Alfredo Focà, Giorgio Fuiano, Daniela Foti, Elio Gulletta, Carlo Torti
Clin Mol Hepatol 2018;24(2):151-162.
Published online April 24, 2018
DOI: https://doi.org/10.3350/cmh.2017.0059
Background/Aims
Correct renal function evaluation is based on estimated glomerular filtration rates (eGFR) and complementary renal damage biomarkers, such as neutrophil gelatinase associated lipocalin (NGAL). The aim of this study was to evaluate eGFR and NGAL modifications and renal impairment during treatment with a direct acting antiviral (DAA) for chronic hepatitis C virus (HCV) infection.
Methods
A retrospective cohort study evaluated eGFR modification during treatment with DAA. Subgroup analysis on serum NGAL was conducted in those receiving sofosbuvir/ledipasvir, with complete follow-up until week 12 after the end of treatment (FU-12).
Result
s: In the 102 enrolled patients, eGFR reduction was observed (from 86.22 mL/min at baseline to 84.43 mL/min at FU-12, P=0.049). Mean NGAL increased in 18 patients (from 121.89 ng/mL at baseline to 204.13 ng/mL at FU-12, P=0.014). At FU-12, 38.8% (7/18) of patients had a plasmatic NGAL value higher than the normal range (36-203 ng/mL) compared with 11.1% (2/18) at baseline (χ 2 =3,704; P=0.054). In contrast, eGFR did not change significantly over the follow-up in this subgroup.
Conclusions
In conclusion, compared to a negligible eGFR decline observed in the entire cohort analyzed, a significant NGAL increase was observed after HCV treatment with DAA in a small subgroup. This could reflect tubular damage during DAA treatment rather than glomerular injury.

Citations

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    Feng Chen, Shan-Shan Wu, Chao Chen, Cheng Zhou
    World Journal of Hepatology.2024; 16(2): 177.     CrossRef
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    Yifan Wang, Xinyan Ma, Yanzheng Zou, Ming Yue, Meiling Zhang, Rongbin Yu, Hongbo Chen, Peng Huang
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    Rosario Cianci, Mariadelina Simeoni, Eleonora Cianci, Oriana De Marco, Antonio Pisani, Claudio Ferri, Antonietta Gigante
    International Journal of Molecular Sciences.2023; 24(5): 4631.     CrossRef
  • Renal Stem Cells, Renal Resistive Index, and Neutrophil Gelatinase Associated Lipocalin Changes After Revascularization in Patients With Renovascular Hypertension and Ischemic Nephropathy
    Rosario Cianci, Mariadelina Simeoni, Antonietta Gigante, Adolfo Marco Perrotta, Sonia Ronchey, Nicola Mangialardi, Annalisa Schioppa, Oriana De Marco, Eleonora Cianci, Cristiana Barbati, Silvia Lai, Claudio Ferri
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    Journal of Clinical and Experimental Hepatology.2021; 11(3): 354.     CrossRef
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    Elisa Biliotti, Donatella Palazzo, Francesca Tinti, Maria Domenica D'Alessandro, Rozenn Esvan, Raffaella Labriola, Andrea Cappoli, Ilaria Umbro, Lorenzo Volpicelli, Alessandra Bachetoni, Erica Villa, Anna Paola Mitterhofer, Paola Rucci, Gloria Taliani
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    Yen-Chun Chen, Chen-Hao Li, Ping-Hung Ko, Chi-Che Lee, Ru-Jiang Syu, Chih-Wei Tseng, Kuo-Chih Tseng, Chen-Hua Liu
    PLOS ONE.2021; 16(8): e0256505.     CrossRef
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Review

Viral hepatitis

Management of hepatitis C viral infection in chronic kidney disease patients on hemodialysis in the era of direct-acting antivirals
Soon Young Ko, Won Hyeok Choe
Clin Mol Hepatol 2018;24(4):351-357.
Published online March 16, 2018
DOI: https://doi.org/10.3350/cmh.2017.0063
The advent of novel, direct-acting antiviral (DAA) regimens for hepatitis C viral (HCV) infection has revolutionized its treatment by producing a sustained virologic response of more than 95% with few side effects and no comorbidities in the general population. Until recently, ideal DAA regimens have not been available to patients with severe renal impairment and end-stage renal disease because there are limited data on the pharmacokinetics, safety, and efficacy of treatment in this unique population. In a hemodialysis context, identifying patients in need of treatment and preventing HCV transmission may also be a matter of concern. Recently published studies suggest that a combination of paritaprevir/ ritonavir/ombitasvir and dasabuvir, elbasvir/grazoprevir, or glecaprevir/pibrentasir successfully treats HCV infection in chronic kidney disease stage 4 or 5 patients with or without hemodialysis.

Citations

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  • The remaining challenges of HCV treatment in the direct‐acting antivirals era
    Beom Kyung Kim, Sang Hoon Ahn
    Journal of Gastroenterology and Hepatology.2019; 34(11): 1891.     CrossRef
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  • 4 Web of Science
  • Crossref

Original Article

Viral hepatitis

Barriers to treatment of failed or interferon ineligible patients in the era of DAA: single center study
Kwang Il Seo, Byung Chul Yun, Weiquan James Li, Sang Uk Lee, Byung Hoon Han, Eun Taek Park
Clin Mol Hepatol 2017;23(1):74-79.
Published online March 3, 2017
DOI: https://doi.org/10.3350/cmh.2016.0052
Background/Aims
Interferon-based treatment is not appropriate for a large number of patients with chronic hepatitis C for various medical and social reasons. Newly developed directly acting antivirals (DAAs) have been used to treat chronic hepatitis C without severe adverse effects and have achieved a sustained viral response (SVR) rate of 80-90% with short treatment duration. We were interested to determine whether all patients who failed to respond to or were ineligible for interferon-based therapy could be treated with DAAs.
Methods
Medical records of patients with positive serum anti-hepatitis C virus (HCV) or HCV RNA between January 2009 and December 2013 were reviewed. Demographic, clinical, and treatment data were collected for analysis.
Result
s: A total of 876 patients were positive for both anti-HCV and HCV RNA. Of these, 244 patients were eligible for interferon, although this was associated with relapse in 39 (16%) of patients. In total, 130 patients stopped interferon therapy (67% adverse effects, 28% non-adherent, 4% malignancy, 1% alcohol abuse) and 502 patients were ineligible (66% medical contraindications, 25% non-adherent, 5% socioeconomic problems). Among 671 patients who were ineligible for or failed to respond to interferon therapy, more than 186 (27.7%) could not be treated with DAA due to financial, social, or cancer-related conditions.
Conclusions
Newly developed DAAs are a promising treatment for patients with chronic hepatitis C who are ineligible for or failed to respond to interferon-based therapy. Nevertheless, not all chronic hepatitis C patients can be treated with DAAs due to various reasons.

Citations

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  • Chronic Hepatitis C Infection Treated with Direct-Acting Antiviral Agents and Occurrence/Recurrence of Hepatocellular Carcinoma: Does It Still Matter?
    Carlo Smirne, Maria Grazia Crobu, Irene Landi, Nicole Vercellino, Daria Apostolo, David James Pinato, Federica Vincenzi, Rosalba Minisini, Stelvio Tonello, Davide D’Onghia, Antonio Ottobrelli, Silvia Martini, Christian Bracco, Luigi Maria Fenoglio, Mauro
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    World Journal of Hepatology.2017; 9(33): 1239.     CrossRef
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  • Crossref

Reviews

Viral hepatitis

Management of direct antiviral agent failures
María Buti, Rafael Esteban
Clin Mol Hepatol 2016;22(4):432-438.
Published online December 25, 2016
DOI: https://doi.org/10.3350/cmh.2016.0107
The current standard of care for patients with chronic hepatitis C virus (HCV) infection is a combination of direct-acting antiviral agents (DAAs). Most HCV patients treated with these drugs achieve viral elimination, but 1% to 15% fail to attain this objective. Treatment failures are usually related to relapse, and less often to on-treatment viral breakthrough. HCV drug resistant associated substitutions are detected in most patients who do not eliminate the virus. The risk of developing these variants depends on host- and virus-related factors, the properties of the drugs used, and the treatment strategies applied. Patients who carry Resistant Associated Substitutions (RASs) may not obtain benefits from treatment, and are at a risk of disease progression. Whether HCV RASs persist depends on their type: NS3-4A variants often disappear gradually after DAA therapy is stopped, whereas NS5A variants tend to persist for more than 2 years. The best way to prevent emergence of resistant variants is to eliminate the virus at the first treatment using highly potent DAAs with genetic barriers to resistance. For those who fail an NS5A inhibitor, deferral of treatment is recommended pending the availability of additional data if they do not have cirrhosis or reasons for urgent re-treatment. If re-treatment is needed, the most commonly used strategy is sofosbuvir as backbone therapy plus a drug from a class other than that previously used, for 24 weeks. Unless it is contraindicated, weight-based ribavirin should also be added. If available, nucleotide-based (eg, sofosbuvir) triple or quadruple DAA regimens may be considered. The optimal treatment for patients who fail an NS5A inhibitor and those with multidrug-resistant variants remains to be defined, and research efforts should continue to focus on treatment for these patients.

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Hepatic neoplasm

The assessment of hepatocellular carcinoma risk in patients with chronic hepatitis B under antiviral therapy
Ioannis Varbobitis, George V. Papatheodoridis
Clin Mol Hepatol 2016;22(3):319-326.
Published online September 25, 2016
DOI: https://doi.org/10.3350/cmh.2016.0045
Hepatocellular carcinoma (HCC) is a primary concern for patients with chronic hepatitis B (CHB). Antiviral therapy has been reasonably the focus of interest for HCC prevention, with most studies reporting on the role of the chronologically preceding agents, interferon-alfa and lamivudine. The impact of interferon-alfa on the incidence of HCC is clearer in Asian patients and those with compensated cirrhosis, as several meta-analyses have consistently shown HCC risk reduction, compared to untreated patients. Nucleos(t)ide analogues also seem to have a favorable impact on the HCC incidence when data from randomized or matched controlled studies are considered. Given that the high-genetic barrier agents, entecavir and tenofovir, are mainly used in CHB because of their favorable effects on the overall long-term outcome of such patients, the most clinically important challenge is the identification of patients who require close HCC surveillance despite on-therapy virological remission. Several risk scores have been developed for HCC prediction in CHB patients. Most of them, such as GAG-HCC, CU-HCC and REACH-B, have been developed and validated in Asian untreated and treated CHB patients, but they do not seem to offer good predictability in Caucasian CHB patients for whom a newer score, PAGE-B, has been recently developed.

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Original Article

Viral hepatitis

Efficacy and safety of daclatasvir and asunaprevir for hepatitis C virus genotype 1b infection
Hee Chul Nam, Hae Lim Lee, Hyun Yang, Myeong Jun Song
Clin Mol Hepatol 2016;22(2):259-266.
Published online June 25, 2016
DOI: https://doi.org/10.3350/cmh.2016.0020
Background/Aims
The treatment strategy for hepatitis C virus (HCV) has been changing rapidly since the introduction of direct-acting antivirals such as daclatasvir (DCV) and asunaprevir (ASV). We evaluated the efficacy and safety of DCV and ASV for HCV in real-life practice.
Methods
Patients were treated with 60 mg of DCV once daily plus 200 mg of ASV twice daily for 24 weeks, and followed for 12 weeks. The primary endpoint was a sustained virological response at 12 weeks after treatment (SVR12) and safety.
Result
s: This retrospective study included eight patients with chronic HCV genotype 1b infection. All of the enrolled patients were diagnosed with liver cirrhosis, and their mean age was 65.75 years. One patient was a nonresponder and two patients relapsed with previous pegylated interferon (PegIFN) and ribavirin (RBV) treatment. None of the patient showed NS5A mutation. An SVR12 was achieved in 88% of cases by the DCV and ASV combination therapy. The serum transaminase level and the aspartate-aminotransferase-to-platelet ratio were improved after the treatment. DCV and ASV were well tolerated in most of the patients, with treatment discontinuation due to adverse events (elevated liver enzyme and decompensation) occurring in two patients.
Conclusions
In this study, combination of DCV and ASV treatment achieved a high sustained virological response with few adverse events even in those with cirrhosis, advanced age, and nonresponse/relapse to previous interferon-based therapy. Close monitoring of safety issues may be necessary when treating chronic HCV patients receiving DCV and ASV, especially in older patient and those with cirrhosis.

Citations

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Review
Chronic hepatitis B in pregnancy: unique challenges and opportunities
Kumaresan Yogeswaran, Scott K. Fung
Korean J Hepatol 2011;17(1):1-8.
Published online March 21, 2011
DOI: https://doi.org/10.3350/kjhep.2011.17.1.1

Chronic hepatitis B (CHB) affects 350 million individuals worldwide. Perinatal transmission leads to high rates of chronic infection and complications, including cirrhosis and hepatocellular carcinoma. It is important to recognize and appropriately treat CHB in pregnancy, thereby reducing the risk of neonatal transmission and HBV-associated morbidity and mortality. Screening for CHB is recommended in all pregnant mothers as is universal vaccination of infants with hepatitis B virus (HBV) vaccine with or without hepatitis B immunoglobulin (HBIG). This has resulted in a lower incidence of HBsAg seropositivity and HCC in regions where universal infant vaccination has been endorsed. Mode of delivery and breastfeeding do not appear to affect HBV transmission rates based on available data. Overall, CHB does not increase perinatal maternal-fetal mortality. Administration of oral antiviral therapy during the third trimester to HBsAg-positive mothers with HBV DNA≥7 log IU/mL may be useful in preventing breakthrough infection. Treatment may be considered earlier in pregnancy for persistently active liver disease shown by high ALT, HBV DNA levels and/or significant hepatic fibrosis. Lamivudine, tenofovir and telbivudine are safe and effective and are the agents of choice in pregnancy. However, further clinical studies are necessary to elucidate the role of antiviral therapy in the pregnant HBV carrier.

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