Global Journal of Digestive Diseases

Direct acting antivirals and hepatocellular carcinoma risk: is it real?

Direct-acting antivirals (DAAs) have completely changed the panorama of hepatitis C due to their high efficacy and optimal safety profile.

The impact of DAA-based treatment on the incidence & recurrence of HCC in patients with cirrhosis and particularly after successful curative treatment is still a controversial issue with potential clinical implication.

 There is a need to differentiate weather the reported higher occurrence and recurrence rates in some studies are due to DAA or host and disease related factors and to identify subset of individuals particularly at risk.

Different reviews showed that using DAAs as the treatment for patients with HCV infection is effective on primary prevention of HCC. More recent and larger studies have demonstrated that successful DAA therapy is associated with a reduction in HCC risk. It is clear that there is a continued risk of HCC recurrence in patients with complete response to HCC therapy who are treated with DAAs. So, continued HCC surveillance should be conducted indefinitely. The residual risk for HCC after achieving SVR justifies surveillance of patients with advanced fibrosis and cirrhosis.

Unexpected heterogenic and incompatible results in most of the studies are due to clinic, biologic, epidemiologic differences and methodological biases..

However, the residual risk for HCC after achieving SVR justifies surveillance of patients with advanced fibrosis.

Further higher-quality studies are needed to determine the consequences of DAA therapy on the risk of HCC recurrence and its aggressiveness in patients that previously underwent HCC treatment.

Author(s):

M.A.Ezzel Arab

Abstract | PDF

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