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Moghe et al. Hepatoma Res 2018;4:36 Hepatoma Research
DOI: 10.20517/2394-5079.2018.54

Review Open Access

Hepatitis C related hepatocellular carcinoma in the
era of direct-acting antivirals

Akshata Moghe, Obaid S. Shaikh

Veterans Affairs Pittsburgh Healthcare System and Division of Gastroenterology, Hepatology and Nutrition, University of
Pittsburgh School of Medicine, Pittsburgh, PA 15240, USA.
Correspondence to: Dr. Obaid S. Shaikh, Veterans Affairs Pittsburgh Healthcare System and Division of Gastroenterology,
Hepatology and Nutrition, University of Pittsburgh School of Medicine, University Drive C, FU #112, Pittsburgh, PA 15240, USA.
E-mail: obaid@pitt.edu
How to cite this article: Moghe A, Shaikh OS. Hepatitis C related hepatocellular carcinoma in the era of direct-acting antivirals.
Hepatoma Res 2018;4:36. http://dx.doi.org/10.20517/2394-5079.2018.54
Received: 7 May 2018 First Decision: 8 Jun 2018 Revised: 20 Jun 2018 Accepted: 26 Jun 2018 Published: 18 Jul 2018

Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Globally, hepatocellular carcinoma (HCC) is the second leading cause of cancer related death. Hepatitis C virus infected
patients with cirrhosis or bridging fibrosis are particularly at risk. The risk is reduced among patients who achieve viral
clearance with interferon-based regimens. Direct-acting antivirals (DAA) have revolutionized the management of HCV
as the treatment is well tolerated, convenient to administer and is highly effective. Earlier studies showed conflicting
results in the effect of DAA induced sustained virologic response (SVR) on the subsequent development or recurrence
of HCC, with some studies showing an increased risk. More recently, two large retrospective studies provided convincing
evidence that DAA induced SVR reduces the risk of HCC development. Irrespective of viral clearance, patients with
cirrhosis and advanced fibrosis and those with treated HCC continue to be at increased risk requiring long-term
surveillance studies.

Keywords: Antiviral agents, viral clearance, hepatoma, hepatitis C virus, cancer surveillance

HCC INCIDENCE - USA AND GLOBAL
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, accounting for
nearly three fourths of all liver cancers . In the last decade, it has been the seventh most common cancer
[1]
in the United States . Yet, with its high lethality and limited effective therapeutic options, it has risen to be
[2]
the second-leading cause of cancer-associated mortality world-wide . In the United States, the incidence
[3]
of HCC has quadrupled in the last four decades, from 1.5 cases per 100,000 in 1973 to 6.2 cases per 100,000

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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