Introduction
Individuals with chronic hepatitis C virus (HCV) infection and cirrhosis have an increased risk of developing severe liver-related complications, including hepatic decompensation, hepatocellular cancer, and death. Accordingly, any person with chronic HCV infection who is diagnosed with compensated cirrhosis should be considered as a high priority for HCV treatment. For persons with chronic HCV infection and decompensated cirrhosis, the treatment plans and goals may need modifying if they are undergoing liver transplantation.
Distinguishing Compensated and Decompensated Cirrhosis
One important step in treating HCV in persons with cirrhosis is to determine whether the cirrhosis is compensated or decompensated.[1,2] The Child-Turcotte-Pugh score is an important component of determining the status of the cirrhosis and predicts morbidity and mortality.[3,4] The treatment approach and goals are divergent based on the classification of compensated versus decompensated cirrhosis. In particular, HCV protease inhibitor-based regimens are not recommended for use in persons with decompensated cirrhosis due to the risk of hepatotoxicity with some medications and lack of data with the others.[5]
- Compensated Cirrhosis: In general, individuals with compensated cirrhosis have mild hepatic impairment (Child-Turcotte-Pugh class A) (Figure 1) and generally do not have clinical manifestations of decompensated disease, specifically jaundice, ascites, variceal hemorrhage, or hepatic encephalopathy.
- Decompensated Cirrhosis: Individuals should be considered to have decompensated cirrhosis if they have moderate or severe liver disease (Child-Turcotte-Pugh class B or C, or a score of 7 or higher). Individuals with decompensated cirrhosis often have experienced one or more of the following: ascites, jaundice, variceal hemorrhage, or hepatic encephalopathy.[1,3] Individuals who have significant clinical improvement after experiencing one feature of hepatic decompensation should be evaluated on a case-by-case basis to determine whether they could be considered for treatment similar to patients with compensated cirrhosis. Even if they recover from the acute event, they are still considered having decompensated cirrhosis.