Impact of direct-acting antivirals on de novo occurrence of hepatocellular carcinoma in hepatitis C virus patients

Abstract

Hepatitis C Virus (HCV) infection constitutes a significant burden to world health, leading to liver cirrhosis and hepatocellular carcinoma (HCC). In the past decades, pegylated interferon combined with ribavirin has been used extensively for HCV treatment, and interferon (IFN) is thought to have antitumor property. Direct-acting antivirals (DAAs) have fundamentally changed HCV therapy, due to their high efficacy and tolerability. However, recent studies have reported relatively high rates of HCC occurrence, and recurrence, following successful HCV treatment using DAAs. These studies were grossly underpowered due to their retrospective design, lack of untreated or IFN controls, small sample size, and limited patient follow-up time. From then, many retrospective and prospective cohort studies with larger size and longer follow-up duration after DAAs therapy have been published. These studies showed that treatment with DAAs can reduce the risk of HCC compared to no treatment, didn’t increase the risk of HCC compared to IFN-based therapy after adjusting for the potential confounders of these two groups, and DAAs-induced sustained virological response decreased the risk of HCC compared to DAAs treatment failure. In conclusion, DAAs treatment doesn’t appear to increase the development of HCC, even in cirrhotic patients. However, cirrhotic patients should be monitored for the development of HCC during and after DAAs treatment