Oral direct-acting antivirals (DAAs) are the main therapy for hepatitis C virus (HCV)-associated liver disease in Japan. Moreover, many DAAs include an indication for compensated liver cirrhosis. However, patients with decompensated HCV-associated cirrhosis have hitherto not been indicated for therapy with DAAs. Recently, a new DAA, sofosbuvir/velpatasvir (SOF/VEL), was indicated for decompensated HCV-associated cirrhotic patients. Actually, it has been shown to eradicate HCV in many cases. However, it is not clear whether hepatic encephalopathy, ascites, and pleural effusion in patients with decompensated HCV-associated cirrhosis disappear by SOF/VEL treatment. Recently, we encountered a decompensated HCV-associated cirrhosis patient who showed the disappearance of hepatic encephalopathy, ascites, and pleural effusion with marked improvement of serum ammonia level, albumin level, prothrombin time, and platelet count after the eradication of HCV by the administration of SOF/VEL. Her consciousness was cloudy and it took many hours for the preparation of each meal just before SOF/VEL treatment, but after the disappearance of HCV-RNA by the therapy, her consciousness became clear and she could prepare meals in a short time. This case suggests the possibility of improvement from decompensated HCV-associated liver cirrhosis to compensated liver cirrhosis with disappearance of hepatic encephalopathy, ascites, and pleural effusion by SOF/VEL therapy.
Case Rep Gastroenterol 2021;15:436–442

中文翻译：

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一名丙型肝炎病毒相关失代偿性肝硬化患者，通过索非布韦/维帕他韦抗病毒治疗，肝性脑病、腹水和胸腔积液消失

口服直接作用抗病毒药物（DAA）是日本丙型肝炎病毒（HCV）相关肝病的主要治疗方法。此外，许多 DAA 包括代偿性肝硬化的适应症。然而，失代偿性 HCV 相关肝硬化患者迄今尚未适应 DAA 治疗。最近，一种新的 DAA，索磷布韦/维帕他韦 (SOF/VEL)，适用于失代偿性 HCV 相关肝硬化患者。事实上，在许多情况下它已被证明可以根除丙肝病毒。然而，尚不清楚失代偿性HCV相关性肝硬化患者的肝性脑病、腹水和胸腔积液是否通过SOF/VEL治疗消失。最近，我们遇到了一位失代偿性HCV相关性肝硬化患者，在根除HCV后，肝性脑病、腹水和胸腔积液消失，血氨水平、白蛋白水平、凝血酶原时间和血小板计数明显改善。 SOF/速度。在SOF/VEL治疗前，她的意识很模糊，准备每顿饭菜都需要几个小时，但在治疗后HCV-RNA消失后，她的意识变得清晰，她可以在短时间内准备饭菜。该病例表明，通过 SOF/VEL 治疗，失代偿性 HCV 相关性肝硬化有可能改善为代偿性肝硬化，肝性脑病、腹水和胸腔积液消失。
胃肠病病例代表 2021 年；15:436–442