Center for Translational Research in Hepatology, Rozzano, Italy.
Department of Medicine, Humanitas Hospital and Humanitas Clinical and Research Center, Rozzano, Italy.
The advent of user friendly and highly successful oral regimens based on direct antiviral agents (DAA), has made a cure of hepatitis C possible in more than 95% of treated patients, including those who were considered difficult to cure with interferon, a vast category including patients with advanced liver disease and those who had a hepatocellular carcinoma (HCC) successfully eradicated by resection or local ablation1 . Despite low rates of treatment uptake and response to therapy with interferon, such hard to treat patients were able to gain significant health benefits, like halting of progression towards liver failure and prevention of second primary tumours, once replication of the hepatitis C virus (HCV) was permanently shut down2,3 . Not surprisingly, the sky rocketing rates of HCV eradication achieved with DAA in these populations, inflated the expectations to gain as significant clinical benefits in parallel4,5 , a prediction that apparently has been confirmed, at least in the short term, by two studies at Veterans Affairs reporting an 80% decline of both all cause mortality and HCC rates in a cohort of 50,000 patients with advanced HCV disease and heavy co-morbidities who had successfully responded to DAA therapies6,7.