Hepatitis C virus infection. From clinical guidelines to clinical practice and personalization of cure

Although clinical guidelines provide clear indications on the treatment of patients with chronic HCV related liver disease, there are still clinical situations in which clinicians experience and judgment remain essential in the proper patient management. These are mainly represented by antiviral therapy in patients with decompensated liver disease, especially if they are candidates for liver transplantation or with significant comorbidities and complex pharmacological therapies. Antiviral retreatment of patients who failed a regimen containing an NS5A protease inhibitor still appears to be a delicate context in which no solid recommendations are provided, especially in patients with HCV genotype 3 and decompensated cirrhosis. The follow-up of patients without cirrhosis who have obtained viral eradication is still controversial, in the absence of prospective clinical trials. With the advent of new drugs and shorter treatments in patients with mild liver disease, the subject of discussion and recommendations could become the evaluation of early HCV viral kinetics after the onset of treatment to decide in every patient when to stop antivirals.