No Single Oral Tablet Cures Liver Cirrhosis
There is no oral tablet that cures liver cirrhosis itself—cirrhosis represents irreversible scarring of the liver. However, specific oral antiviral tablets can cure the underlying hepatitis C infection that causes cirrhosis, potentially preventing progression and allowing some reversal of fibrosis in compensated cirrhosis 1.
Understanding What Can Be Treated
Hepatitis C Can Be Cured, Not Cirrhosis Itself
- Single-tablet regimens exist to cure hepatitis C virus (HCV) infection in patients with compensated cirrhosis, achieving sustained virologic response (SVR) rates of 95-100% 1.
- The fixed-dose combination of sofosbuvir/velpatasvir (400 mg/100 mg) administered once daily for 12 weeks without ribavirin achieves SVR12 in 98% of HCV genotype 1 patients with compensated cirrhosis 1.
- Glecaprevir/pibrentasvir administered for 12 weeks achieves high SVR rates in treatment-naïve patients with compensated cirrhosis across multiple HCV genotypes 1.
Critical Distinction: Compensated vs. Decompensated Cirrhosis
- These curative HCV regimens are only appropriate for compensated (Child-Pugh A) cirrhosis 1.
- Patients with decompensated cirrhosis (Child-Pugh B or C) require different treatment approaches and have absolute contraindications to interferon-based regimens 1.
- Decompensated cirrhosis with complications (ascites, hepatic encephalopathy, variceal bleeding) has median survival of approximately 1 year and requires liver transplantation evaluation 2.
What Cirrhosis Actually Requires
Management, Not Cure
- Cirrhosis management focuses on treating complications and preventing progression, not reversing established scarring 3, 2.
- First-line therapies include carvedilol or propranolol to prevent variceal bleeding (reducing decompensation risk from 27% to 16% over 3 years), lactulose for hepatic encephalopathy (reducing mortality from 14% to 8.5%), and combination aldosterone antagonists with loop diuretics for ascites 2.
- Patients should be evaluated for liver transplantation when Model for End-stage Liver Disease (MELD) score reaches 15 or greater, or when complications develop 3.
Medications to Avoid in Cirrhosis
- NSAIDs should be avoided in advanced cirrhosis due to risk of precipitating renal failure and counteracting the renin-angiotensin system 4, 5.
- ACE inhibitors carry high risk of excessive hypotension or acute renal failure in advanced liver disease 5.
- Proton pump inhibitors increase risk of spontaneous bacterial peritonitis and should be used cautiously 4.
- Potentially hepatotoxic drugs should be avoided when alternatives exist, though most medications can be used safely with dose adjustments 6, 4.
Common Pitfall to Avoid
Do not confuse curing the underlying cause (such as HCV) with curing cirrhosis itself. While successful HCV eradication can prevent further liver damage and allow some fibrosis regression in compensated cirrhosis, established cirrhosis with decompensation remains irreversible and requires transplantation for definitive treatment 3, 2. The single-tablet HCV regimens represent disease-modifying therapy for the underlying etiology, not a cure for cirrhosis as a pathologic entity.