Decompensated
cirrhosis has traditionally been considered a
contraindication to
interferon and
ribavirin therapy. Whereas, the same may be true for advanced
cirrhosis, which is only successfully amenable to
liver transplantation (LT), there are reports in the literature in which
antiviral therapy was given successfully in selected cases of early hepatic decompensation with an aim to attain sustained viral clearance, halt
disease progression, and expect potential (though, often, partial) recovery of hepatic metabolic activity.
Antiviral therapy may also be instituted to prevent
hepatitis C recurrence after LT (it has even caused removal of some patients from the waiting list for LT). Thus, decompensation per se is no more an absolute
contraindication to
antiviral therapy. Nonetheless, considering that a large proportion of such patients have pre-existing hematological
cytopenias, modifications in
antiviral dose regimens and close monitoring is required in order to prevent worsening of the same. Although the final sustained virological response rates attained in these patients are relatively low, successful
antiviral therapy is potentially lifesaving which explains the need to go for it. In this article, the pros and cons of
antiviral therapy in decompensated
liver cirrhosis are reviewed with special emphasis on how to avoid
antiviral dose reductions/withdrawals secondary to the development of hematologic side effects by using hematopoietic
growth factors.