Epidemic management in a measles outbreak in 2023,the return of vaccine-preventable diseases:A single center,retrospective observational study

Objective:To investigate the importance of immunization in preventing measles infection and to determine the most useful laboratory tests for confirmation of measles.Methods:This study included pediatric cases evaluated with a presumed diagnosis of measles between December 2022 and June 2023,at Marmara University Pendik Training and Research Hospital.The effects of vaccination status and underlying disease on the clinical course,treatments,and complications were evaluated.Results:In total,117 patients were enrolled in the study with a median age of 80 months(IQR:32.5-125.0).Twelve patients with contact history were asymptomatic and had an underlying disorder,and intravenous immunoglobulin was given to them for post-exposure prophylaxis.Fifty-one patients had confirmed measles diagnosis.Ribavirin treatment was given to three patients(a newborn,a girl with rhabdomyosarcoma,and a healthy boy)with respiratory distress.Seventy-eight percent of confirmed measles cases were unvaccinated,and all hospitalized cases were unvaccinated or under-vaccinated.Four full-vaccinated children had confirmed measles infection.Measles PCR from nasopharyngeal swabs was negative in all of them,and their diagnosis was established with anti-measles IgM positivity.Conclusions:The measles vaccine is the most effective way to protect from measles and measles-related complications.Although measles can also occur in fully vaccinated patients,the disease is milder than in unvaccinated patients.Using ELISA and RT-PCR tests together may be beneficial in patients with high clinical suspicion for early diagnosis.

Inhibition of Eukaryotic Initiating Factor eIF4E Overcomes Abemaciclib Resistance in Gastric Cancer

Objective Aberrant activating mutations in cyclin-dependent kinases 4 and 6(CDK4/6)are common in various cancers,including gastroesophageal malignancies.Although CDK4/6 inhibitors,such as abemaciclib and palbociclib,have been approved for breast cancer treatment,their effectiveness as a monotherapy remains limited for gastroesophageal tumors.The present study explored the underlying mechanism of abemaciclib resistance.Methods Abemaciclib-resistant gastric cancer cell lines were generated,and the phospho-eukaryotic translation initiation factor 4E(p-eIF4E)and eIF4E expression was compared between resistant and parental cell lines.In order to analyze the role of eIF4E in cell resistance,siRNA knockdown was employed.The effectiveness of ribavirin alone and its combination with abemaciclib was evaluated in the gastric cancer xenograft mouse model.Results The upregulation of eIF4E was a common feature in gastric cancer cells exposed to prolonged abemaciclib treatment.Gastric cancer cells with increased eIF4E levels exhibited a better response to eIF4E inhibition,especially those that were resistant to abemaciclib.Ribavirin,which is an approved anti-viral drug,significantly improved the efficacy of abemaciclib,both in vitro and in vivo,by inhibiting eIF4E.Importantly,ribavirin effectively suppressed the abemaciclib-resistant gastric cancer growth in mice without causing toxicity.Conclusion These findings suggest that targeting eIF4E can enhance the abemaciclib treatment for gastric cancer,proposing the potential combination therapy of CDK4/6 inhibitors with ribavirin for advanced gastric cancer.

Glecaprevir/pibrentasvir+sofosbuvir for post-liver transplant recurrent hepatitis C virus treatment

Glecaprevir/pibrentasvir in combination with sofosbuvir may serve as a safe and effective option for treatment of recurrent hepatitis C virus post-liver transplant in patients who previously failed direct-acting antivirals.

抗丙型肝炎病毒新药索非布韦的研究进展

全世界约1.7-2.0亿人（占世界人口的3%）长期感染丙型肝炎病毒（hepatitis C virus,HCV）。HCV感染可导致肝硬化及其并发症,如肝细胞癌。流行病学研究结果显示,每年有〉35万人死于与HCV相关的肝脏疾病。慢性丙型病毒性肝炎的标准治疗方案为聚乙二醇（polyethylene glycol,PEG）干扰素（interferon,IFN）联合利巴韦林（ribavirin,RBV）,但其不良反应明显、治疗周期长且患者依从性差，临床应用受限.

干扰素γ诱导蛋白10与慢性丙型病毒性肝炎感染患者干扰素抗病毒疗效关系的研究进展

目前,聚乙二醇干扰素（pegylatedinterferon,PEG-IFN）联合利巴韦林（ribavirin,RBV）仍为治疗慢性丙型肝炎的主要方案,但部分患者正规治疗后仍不能获得持久病毒学应答（sustained viral response,SVR）。近年研究发现：许多宿主因素与抗病毒治疗疗效相关,如IL28B基因多态性及干扰素γ诱导蛋白10（interferon gamma inducible protein 10,IP-10）与HCV感染的慢性化及接受聚乙二醇干扰素联合利巴韦林抗病毒治疗的慢性丙型肝炎（chronic hepatitis C，CHC）患者的病毒学应答有关联。

《丙型肝炎指南(2015年更新版)》解读之变革的HCV基因型

2015年10月,中华医学会感染病学分会与肝病学分会联合更新了《慢性丙型肝炎防治指南（2015年更新版）》[1]（以下简称《指南》）。《指南》结合最新的慢性丙型肝炎（chronic hepatitis C,CHC）循证医学证据,对于现阶段我国CHC的防治给出了指导性的意见。从丙型肝炎病毒（hepatitis C virus,HCV）基因型的角度而言,新版指南就我国HCV基因型分布、基因型与肝脏病理表现、

抗丙型肝炎病毒药的研究进展与临床应用评价

丙型病毒性肝炎是丙型肝炎病毒（hepatitis C virus，HCV）感染引起的疾病，主要经血液传播。据世界卫生组织统计，全世界1.85亿人感染HCV，感染率约3％，其中慢性丙型肝炎约占70％～85％，部分进展为肝硬化或肝细胞癌。由于公众对HCV感染及其危害的知晓度有限，造成治疗时机延误或错失治疗机会，引起疾病进展，对人类的健康和生命构成危害，已成为严重的社会和公共卫生问题。 HCV 的抗病毒治疗始于20世纪90年代初，采用干扰素（interferon，IFN）单独治疗，后来治疗方案逐渐发展为IFN联合利巴韦林（ribavirin，RBV）、长效IFN联合 RBV等，但临床疗效有限，不良反应较严重。近几年，蛋白酶抑制剂的研发上市给丙型病毒性肝炎的治疗带来了新的希望。蛋白酶抑制剂是一类直接抗病毒药（ direct-acting antiviral agents ，DAA），临床研究表明，这类药物对可明显提高抗HCV的初治疗效，也可用于对既往IFN治疗无应答或治疗反弹的经治患者，对于不能耐受IFN治疗或不适合的患者也有良好应答。现对抗HCV的药物治疗进展进行综述。

Treatment of Chronic Viral Hepatitis with Pegylated Interferon in Ivory Coast

Background: In the Ivory Coast, chronic infection by hepatitis B and C virus is the leading cause of cirrhosis and hepatocellular carcinoma. The absence of universal health coverage makes the treatment inaccessible to all. Objectives: To assess the efficacy of Pegylated Interferon in clinical practice in patients with chronic viral hepatitis B and C and determine the hematologic side effects. Patients and Methods: A descriptive retrospective study from January 2012 to November 2013 on a cohort of patients chronic carriers of hepatitis B virus (n = 11) treated with Pegylated Interferon to 180 mcg per week and hepatitis C virus (n = 30) treated with a combination therapy associating pegylated Interferon to 180 mcg per week and Ribavirin assayed according to the genotype. Results: Out of 1860 patients seen in hepatogastroenterology consultation 422 had viral hepatitis B or C that is a prevalence of 22.7% and 41 patients were treated (9.7%) by Pegylated Interferon. Among these 41 patients mentioned earlier, 30 had HCV (73.17%) with a case of HIV + HVC co-infection, 11 patients had HBV (26.83%) including 3 cases of HBV + HDV co-infection. Patients’ age ranged from 24 - 69 years with an average of 49.2 ± 12.2 years including 46.5 years for HBV and 51.9 years for HCV. The sex ratio was 1.56. The original transaminases were on average 93.37 IU/l for AST and 110.47 for ALT. The average RNA HCV was 1,685,331 IU/ml and the DNA HBV 33,312,767 IU/ml. Patients with HCV were of genotype 1 in 56.66%, genotype 2 in 40% and one case of genotype 4 (3.34%) from Central Africa. Fibrosis score at institution of treatment was significant (≥A2 and/or ≥F2) in 86.9% of cases of Fibrotest®, 100% of cases of Fibrometer®. We observed 48.8% of neutropenia < 750/mm3, 33.3% of anemia and 29.3% of thrombocytopenia < 100,000/mm3. There was no dose reduction of Pegylated Interferon and Ribavirin. For HBV there were 3 partial responses, 3 responders including 1 HBV + HDV co-infected non responder to HDV, 2 non responders including 1 HBV + HDV co-infected to Week 48. For HCV, there was 52.94% of cases of sustained viral response (SVR) including 44.44% of genotype 1, 83.33% of genotype 2 and 100% of genotype 4. Conclusion: The free antiviral treatment program helped treat 10% of chronic viral hepatitis B and C. Our results are not different from those of the literature. Difficulties remain in the performance of non supported diagnostic tests.

抗丙型肝炎药物研究进展——药物、靶点和耐药性

丙型肝炎为丙型肝炎病毒（hepatitis C virus，HCV）引起的全球性传染病。目前全球感染率约为3%，感染者约2亿人[1]。我国在2010年公布了一般人群的血清抗 HCV阳性率为0.43%。丙型肝炎以输血为主要传播途径。15%~40%的感染者6个月内感染症状可自行消失[2-3]，剩余60%~85%发展为慢性丙型肝炎[4]，其中约20%的慢性丙型肝炎患者在慢性感染 HCV 后20年左右的时间内发展为肝硬化甚至肝脏衰竭或 HCV 相关的肝细胞癌（hepatocellular carcinoma，HCC）[5]。目前丙型肝炎的预防尚无疫苗可用。早期最有效的丙型肝炎标准治疗方案是聚乙二醇（PEG）化干扰素α（PEG-IFN-α）与利巴韦林（ribavirin， RBV）联合应用24~48周，但只有40%~50%的基因型为1型患者和约80%的基因型为2或3型患者得到有效治愈[6-8]。2011年，新的标准三联疗法获美国 FDA 认证，该疗法在传统抗丙型肝炎标准方案（PEG-IFN-α和利巴韦林联合用药）基础上加入了两种新批准的蛋白酶抑制剂中的一种，使得对 HCV 基因1型感染治愈率提高到约70%[9-10]，但是其副反应、抗药性以及药物间相互作用等问题依然严重[11]。

Combination of "low-dose" ribavirin and interferon alfa-2a therapy followed by interferon alfa-2a monotherapy in chronic HCV-infected nonresponders and relapsers after interferon alfa-2a monotherapy

AIM To report on the efficacy, safety and tolerability of interferon alfa-2a combined with a "low dose" of ribavirin for relapsers and non responders to alpha interferon monotherapy.METHODS Thirty-four chronic hepatitis C virus-infected non-responders to interferon alfa2a monotherapy (a course of at least 3 months treatment) and 13 relapsers to interferon alfa 2a monotherapy (a dose of 3 to 6 million units three times per week for at least 20 weeks but not more than 18 months) were treated with the same dose of interferon alfa-2a used before (3 to 6 million units three times per week) and ribavirin (10 mg/ kg daily) for 6 months. In complete responders, interferon alfa-2a was administered for further 6 months at the same dose used before as monotherapy.RESULTS Seven (20.6%) of 34 non-responders stopped the combined therapy due to adverse events, including two patients with histological and clinical Child A cirrhosis. In 17/27 (63%)non-responders, the combined therapy was stopped after three months because of non-response. Ten of the 27 non-responders completed the 1;2-month treatment course. At a mean follow up of 28 months (16- 37 months)after the treatment, 4/10 (15%) previous non-responders still remained complete responders,All 13 previous relapsers completed the 12-month treatment course. At a mean follow up of 22months (9 - 36 months) after treatment, 6/13(46%) the previous relapsers were stillsustained complete responders.CONCLUSION Our treatment schedule of the combined therapy for 6 months of interferon alfa2a with a low dose of ribavirin (10 mg/kg/day)followed by 6 months of interferon alfa-2amonotherapy is able to induce a sustainedcomplete response rate in 15% of non-responders and 46% of relapsers with chronic hepatitis C virus-related liver diseases comparable to those obtained with the standarddoses of ribavirin 1000 - 1200 mg/day.Randomized prospective controlled trials using lower total amounts of ribavirin in combination with interferon should be performed.

Hepatitis C and HIV co-infection:a review

Co-infection with hepatitis C virus and humanimmunodeficiency virus is common in certainpopulations. Among HCV(+) persons, 10 % are alsoHIV (+), and among HIV (+) persons, 25 % are alsoHCV(+). Many studies have shown that in intravenousdrug users, co-infection prevalence can be as high as90-95 %. There is increasing evidence supporting theconcept that people infected with HIV have a muchmore rapid course of their hepatitis C infection.Treatment of co-infection is often challenging becausehighly active anti-retroviral therapy (HAART) therapyis frequently hepatotoxic, especially in the presence ofHCV. The purpose of this review is to describe theeffects that HIV has on hepatitis C, the effects thathepatitis C has on HIV, and the treatment options inthis challenging population.

Insulin resistance and hepatitis C

Insulin resistance is the major feature of the metabolic syndrome and depends on insulin secretion and insulin sensitivity. In chronic hepatitis C, insulin resistance and type 2 diabetes mellitus are more often seen than in healthy controls or chronic hepatitis B patients. Hepatitis C virus （HCV） infection promotes insulin resistance, mainly by increased TNF production together with enhancement of suppressor of cytokine （SOC-3）; both events block PI3K and Akt phosphorylation. Two types of insulin resistance could be found in chronic hepatitis C patients＇. ＂viral＂ and ＂metabolic＂ insulin resistance. Insulin resistance in chronic hepatitis C is relevant because it promotes steatosis and fibrosis. The mechanisms by which insulin resistance promotes fibrosis progression include： （1） steatosis, （2） hyperleptinemia, （3） increased TNF production, （4） impaired expression of PPARy receptors. Lastly, insulin resistance has been found as a common denominator in patients difficult-to-treat like cirrhotics, overweight, HIV coinfected and Afro-American. Insulin resistance together with fibrosis and genotype has been found to be independently associated with impaired response rate to peginterferon plus ribavirin. Indeed, in genotype 1, the sustained response rate was twice （60%） in patients with HOMA ≤ 2 than patients with HOMA 〉 2. In experiments carried out on Huh-7 cells transfected by full length HCVRNA, interferon alpha blocks HCV replication. However, when insulin （at doses of 128 μU/mL, similar that seen in the hyperinsulinemic state） was added to interferon, the ability to block HCV replication disappeared, and the PKR synthesis was abolished. In summary, hepatitis C promotes insulin resistance and insulin resistance induces interferon resistance, steatosis and fibrosis progression.

Spectrum of anemia associated with chronic liver disease

Anemia of diverse etiology is a common complication of chronic liver diseases. The causes of anemia include acute or chronic gastrointestinal hemorrhage, and hypersplenism secondary to portal hypertension. Severe hepatocellular disease predisposes to hemorrhage because of impaired blood coagulation caused by deficiency of blood coagulation factors synthesized by hepatocytes, and/or thrombocytopenia. Aplastic anemia, which is characterized by pancytopenia and hypocellular bone marrow, may follow the development of hepatitis. Its presentation includes progressive anemia and hemorrhagic manifestations. Hematological complications of combination therapy for chronic viral hepatitis include clinically signif icant anemia, secondary to treatment with ribavirin and/or interferon. Ribavirininduced hemolysis can be reversed by reducing the dose of the drug or discontinuing it altogether. Interferons may contribute to anemia by inducing bone marrow suppression. Alcohol ingestion is implicated in the pathogenesis of chronic liver disease and may contribute to associated anemia. In patients with chronic liver disease, anemia may be exacerbated by defi ciency of folic acid and/or vitamin B12 that can occur secondary to inadequate dietary intake or malabsorption.

Effect of the Haoqinqingdan decoction on damp-heat syndrome in rats with influenza viral pneumonia

Objective: To investigate the effect of Chinese medicine prescription-Haoqinqingdan decoction on damp-heat syndrome in rats with influenza viral pneumonia and its influence on the immune function. Methods: A total of 48 Wistar rats were randomly divided into the normal control group, the damp-heat syndrome model group, the Haoqinqingdan decoction group (high, medium and low dose group) and the ribavirin group. The body temperature and weight of rats in each group were recorded after modeling. After treatment for 6 d, the concentration of T lymphocyte subgroup (CD3+ CD4+ , CD3+ CD8+ ) was determined by flow cytometry. The OD value of IFN毭/IL-4 was detected by double-antibody sandwich ELISA method, and its concentration was acquired through conversion. Results: After modeling, the temperature and weight of rats in each modeling group showed the increasing trend ( P<0.01). From the second day of treatment, there was significant difference in the body mass between groups, and the rat weight of the control group was higher than in the modeling group ( P<0.05 or 0.01). With the advances of treatment, only the temperature in the medium and high dose Haoqinqingdan decoction groups declined significantly ( P<0.05). After treatment, the CD4+ /CD8+ ratio of the damp-heat syndrome model group decreased more significantly compared with the control group. Elevated CD3+ CD8+ percentages and declined CD4+ /CD8+ ratios can be observed in the low dose group and ribavirin group ( P<0.05). Moreover, the CD3+ CD4+ percentage of ribavirin group was lower than in the control group ( P<0.05). After treatment, the IFN-毭 and IFN-毭/ IL-4 levels in the peripheral blood of rats in the dampheat syndrome group were obviously higher than in the control group ( P<0.05). Conclusions: Compared with ribavirin, the high dose Haoqinqingdan decoction can improve the ratio of T lymphocyte subgroup and Th1/Th2 cell balance more effectively.

IL28B polymorphisms associated with therapy response in Chilean chronic hepatitis C patients

AIM:To analyze the association of three IL28B single nucleotide polymorphisms with response to therapy in Chilean patients infected with hepatitis C virus CV.METHODS:We studied two groups of patients with chronic CV infection genotype 1,under standard combined treatment with pegylated interferon plus ribavirin.One group consisted of 50 patients with sustained virological response,whereas the second group consisted of 49 null responders.In order to analyze the IL28B single nucleotide polymorphisms rs12979860,rs12980275 and rs8099917,samples were used for polymerase chain reaction amplification,and the genotyping was performed by restriction fragment lengthpolymorphism.RESULTS:The IL28B rs12979860 CC,rs12980275 AA and rs8099917 TT genotypes were much more frequently found in patients with sustained virological response compared to null responders 38%,44% and 50% vs 2%,8.2% and 8.2%,respectively.These differences were highly significant in all three cases(P < 0.0001.CONCLUSION:The three IL28B polymorphisms studied are strongly associated with sustained virological response to therapy in Chilean patients with chronic CV genotype 1.

Management of hepatitis C virus infection in HIV/HCV co-infected patients: Clinical review

Nearly one fourth of individuals with human immunodeficiency virus (HIV) infection have hepatitis C virus (HCV) infection in the US and Western Europe. With the availability of highly active antiretroviral therapy and the consequent reduction in opportunistic infections, resulting in the prolongation of the life span of HIV-infected patients, HCV co-infection has emerged as a signif icant factor influencing the survival of HIV patients. Patients with HIV/HCV co-infection have a faster rate of fibrosis progression resulting in more frequent occurrences of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. However, the mechanism of interaction between the two viruses is not completely understood. The treatment for HCV in co-infected patients is similar to that of HCV monoinfection; i.e., a combination of pegylated interferon and ribavirin. The presence of any barriers to antiHCV therapy should be identified and eliminated in order to recruit all eligible patients. The response to treatment in co-infected patients is inferior compared to the response in patients with HCV mono-infection. The sustained virologic response rate is only 38% for genotype-1 and 75% for genotype-2 and -3 infections. Liver transplantation is no longer considered a contraindication for end-stage liver disease in coinfected patients. However, the 5 year survival rate is lower in co-infected patients compared to patients with HCV mono-infection (33% vs 72%, P = 0.07). A better understanding of liver disease in co-infected patients is needed to derive new strategies for improving outcome and survival.

Treatment responses in Asians and Caucasians with chronic hepatitis C infection

AIM：To conduct a multicentre retrospective review of virological response rates in Asians infected with genotype 1 chronic hepatitis C（CHC） treated with combination interferon and ribavirin and then to compare their responses to that among Caucasians.METHODS：Asian patients infected with genotype 1 CHC treated at 4 Australian centres between 2001 to 2005 were identified through hospital databases.Baseline demographic characteristics,biochemical,virological and histological data and details of treatment were collected.Sustained virological responses（SVR） in this cohort were then compared to that in Caucasian subjects,matched by genotype,age,gender and the stage of hepatic fibrosis.RESULTS：A total of 108 Asians with genotype 1 CHC were identified.The end of treatment response（ETR） for the cohort was 79% while the SVR was 67%.Due to the relatively advanced age of the Asian cohort,only sixty-four subjects could be matched with Caucasians.The ETR among matched Asians and Caucasians was 81% and 56% respectively（P=0.003）,while the SVR rates were 73% and 36%（P 〈0.001） respectively.This difference remained significant after adjusting for other predictive variables. CONCLUSION： Genotype 1 CHC in Asian subjects is associated with higher rates of virological response compared to that in Caucasians.

Interferon alpha plus ribavirin combination treatment of Japanese chronic hepatitis C patients with HCV genotype 2:A project of the Kyushu University Liver Disease Study Group

AIM： To determine the efficacy of an interferon alpha and ribavirin combination treatment for Japanese patients infected with hepatitis C virus （HCV） of genotype 2, a multi-center study was retrospectively analyzed. METHODS： In total, 173 patients with HCV genotype 2 started to receive interferon-alpha subcutaneously thrice a week and 600-800 mg of ribavirin daily for 24 wk. RESULTS： The overall sustained virological response （SVR）, defined as undetectable HCV RNA in serum, 24 wk after the end of treatment, was remarkably high by 84.4%, （146/173） by an intention-to-treat analysis. A significant difference in SVR was found between patients with and without the discontinuation of ribavirin （46.9% vs 92.9 %）, but no difference was found between those with and without a dose reduction of ribavirin. A significant difference in SVR was also found between patients with less than 16 wk and patients with 16 or more weeks of ribavirin treatment （34.8 % vs 92.0 %）. CONCLUSION： The 24-wk interferon and ribavirin treatment is highly effective for Japanese patients with HCV genotype 2. The significant predictor of SVR is continuation of the ribavirin treatment for up to 16

Peginterferon and ribavirin treatment for hepatitis C virus infection

Pegylated interferon α (IFNα) in combination with ribavirin is currently recommended as a standard-of-care treatment for chronic hepatitis C virus (HCV) infection. This combination therapy has drastically improved the rate of sustained virological response, specifically in difficult-to-treat patients. Recently, individualized treatment, such as response-guided therapy, is being developed based on host-, HCV- and treatment-related factors. Furthermore, modified regimens with currently available medications, novel modified IFNα and ribavirin or combinations with specifically targeted antiviral therapy for HCV agents, are currently being investigated. The purpose of this review is to address some issues and epoch-making topics in the treatment of chronic HCV infection, and to discuss more optimal and highly individualized therapeutic strategies for HCV-infected patients.

Antiviral therapy in hepatitis C virus cirrhotic patients in compensated and decompensated condition

The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance(SVR),halt disease progression,and prevent re-infection of the liver graft.However,while the medical need is great,the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias.We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis,due to hepatitis C virus(HCV) infection.In cases presenting with bridging fibrosis or cirrhosis,current regimens of antiviral therapy have attained a 44%-48% rate of SVR.In cirrhotic patients with portal hypertension,the SVR rate was 22% overall,12.5% in patients with genotype 1,and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin.In patients with decompensated cirrhosis,full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall,16% in patients with genotype 1 and 4,and 59% in those with genotype 2 and 3.Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects.Major benefits after HCV eradication were partial recovery of liver metabolic activity,prevention of hepatitis C recurrence after transplantation,and removal of some patients from the waiting list for liver transplant.Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve(Child-Pugh-Turcotte score ≥ 10).Although SVR rates are low indecompensated cirrhotics due to hepatitis C,these patients have the most to gain as successful antiviral therapy is potentially lifesaving.