Antiviral Therapy for Chronic HCV Infection - Tolerability and Outcome

This thesis describes the safety and outcome of antiviral therapy for chronic HCV infection. In the first chapters, the authors investigated (hematological) adverse events during interferon-based therapy among patients with compensated cirrhosis. By using a patient-tailored approach, interferon-based treatment can be optimized. The authors also assessed the trends in patient characteristics over time and concluded that the population with chronic HCV infection is aging and more often referred with advanced liver disease. With the introduction of highly effective and very safe direct-acting antivirals, more patients were able to achieve a sustained virological response (SVR). However, treatment uptake is hampered by the high costs. Therefore, the authors assessed the costs per SVR for interferon-based treatment among patients with advanced hepatic fibrosis and found that these costs were higher for patients with more advanced liver disease. The last three chapters focus on antiviral treatment with direct-acting antivirals, which results in high SVR rates and are very safe. Some patients may benefit from deferring treatment post liver transplantation. Renal impairment during sofosbuvir-based treatment is uncommon and mostly transient.

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