Cirrhosis is less cirrhosis without virus C.

A, et al. Association between sustained virological response and all-cause mortality among patient with chronic hepatitis C and advanced hepatic fibrosis. COMMENTS In the current commented article, van der Meer, et al. demonstrated that sustained virological response in patients with advanced fibrosis was associated with lower overall mortality, lower liver-related mortality including liver failure and liver cancer. No patient achieving sustained virolo-gical response required liver transplantation and liver related mortality was more than 15 times lower (30 vs. 2%). Hepatocellular carcinoma rate was also reduced in comparison with non-responders but a significant risk remained. Cumulative HCC occurrence was 5.1% at 10 years vs. 21.8% in non-SVR. Genotype 3a, type 2 diabetes mellitus, older age, male gender, heavy alcohol consumption and histo-logical cirrhosis were associated with increased risk of liver cancer. 1 Sustained virological response, the negativity of HCV RNA at 6 months after the end of therapy, is a stable condition and it has been accepted as synonymous of cure of chronic hepatitis C. However, whether the meaning is the same in cirrhosis remains controversial. The inability of the virus to become part of the human genome allowed antiviral drugs to eradicate the infection. Genetic, metabolic, viral and environmental factors influenced fibrosis progression , but in patients with chronic hepatitis C, HCVRNA replication remains as the major factor , mainly because its eradication has been related to fibrosis or even cirrhosis regression. 2 HCV eradi-cation has been associated with decreased 10 years mortality near three times and more than 15 times liver-related mortality supporting the idea that virus clearance allowed to the liver to restore hepatic function, even in cirrhotics. Previous data supported an improvement of liver function after sustained virological response but this prolonged follow-up allowed the author to demonstrate how big was the gap between responders and non-responders. Interestingly , none of patients with SVR underwent liver transplantation. Hepatitis C is the major cause of liver transplantation indication in USA and thus, its effective eradication could avoid liver transplanta-tion. In addition, hepatocellular carcinoma in HCV infected patients showed more aggressive tumour features in comparison with non-alcoholic steatohe-patitis-related HCC. 3 In the sequence hepatitis C infection, HCV replication, hepatic stellate cell activation, fibrosis progression, cirrhosis stage, liver failure, hepatocellular carcinoma, liver trans-plantation and death, if we attack the beginning we can control the disease and its complications, encouraging us to treat and cure our patients. Pro-tease inhibitors boceprevir and …