Direct-acting antiviral agents (DAAs) are the main antiviral therapeutics for hepatitis C virus-related decompensated stage cirrhosis. DAAs of NS3/4A protease inhibitors use is not recommended for patients with decompensated cirrhosis due to characteristics of DAAs metabolism in liver. The recent guidelines have recommended sofosbuvir (SOF)-based plan including pan-genotype plan of sofosbuvir(SOF)/velpatasvir (VEL), sofosbuvir combined with daclatasvir (DCV), genotype 1,4,5,6 specific plan of sofosbuvir (SOF) / ledipasvir (LDV) for 24 weeks or above in combination with ribavirin for 12 weeks because NS5B and NS5A inhibitors has no obvious effect on CYP450 enzyme system and achievement of sustained virological response (SVR) rates at 12/24 weeks is achievable in 88% ~ 100%, and liver reserve function improves in 42% ~ 53% of patients. Furthermore, approximately 15.5% ~ 49% of patients waiting for liver transplantation after treatment with DAAs do not require liver transplantation for short-term and 10.3% ~19.2% of patients receiving SOF/LDV, and SOF combined with DCV not needed liver transplantation. Thus, the clinical application of DAAs provides a safe and reliable antiviral treatment plan for hepatitis C virus-related decompensated stage cirrhosis.
直接抗病毒药物为丙型肝炎肝硬化失代偿期的主要抗病毒治疗药物，根据药物代谢特点，不建议经肝脏代谢的NS3/4A蛋白酶抑制剂类直接抗病毒药物用于失代偿期肝硬化患者。NS5B、NS5A抑制剂对CYP450酶系无明显影响，近年指南推荐以索磷布韦为基础方案，包括泛基因型方案索磷布韦/维帕他韦、索磷布韦联合达拉他韦，1，4，5，6型特异性方案索磷布韦/来迪派韦24周或上述方案联合利巴韦林12周，12/24周持续病毒学应答率可达88%～100%，42%～53%患者肝脏储备功能改善。等待肝移植患者中经直接抗病毒药物治疗，约15.5%～49%暂时不需肝移植，索磷布韦/来迪派韦、索磷布韦联合达拉他韦治疗患者10.3%～19.2%免于肝移植。直接抗病毒药物的临床应用为失代偿期丙型肝炎肝硬化提供了安全可靠的抗病毒治疗方案。.
Keywords: Decompensation of liver function; Directed-acting antiviral agents; Hepatitis C virus; Liver cirrhosis.