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Burlone et al. Hepatoma Res 2020;6:3 Hepatoma Research
DOI: 10.20517/2394-5079.2019.37

Original Article Open Access

Response rates to direct antiviral agents among
hepatitis C virus infected patients who develop

hepatocellular carcinoma following direct antiviral
agents treatment

Michela Emma Burlone , Stefano Fangazio , Alessandro Croce , Elisa Ceriani , Rachele Rapetti , Cristina
1
2
1
1
1
Rigamonti , Carlo Smirne , Stelvio Tonello , Paolo Ravanini , Rosalba Minisini , Mario Pirisi 1,2
1,2
2
2
1,2
3
1 Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara 28100, Italy.
2 Department of Translational Medicine, Università del Piemonte Orientale, Novara 28100, Italy.
3 Laboratory of Virology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara 28100, Italy.
Correspondence to: Prof. Mario Pirisi, Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Corso
Mazzini 18, Novara 28100, Italy. E-mail: mario.pirisi@uniupo.it
How to cite this article: Burlone ME, Fangazio S, Croce A, Ceriani E, Rapetti R, Rigamonti C, Smirne C, Tonello S, Ravanini P,
Minisini R, Pirisi M. Response rates to direct antiviral agents among hepatitis C virus infected patients who develop hepatocellular
carcinoma following direct antiviral agents treatment. Hepatoma Res 2020;6:3. http://dx.doi.org/10.20517/2394-5079.2019.37
Received: 29 Nov 2019 First Decision: 31 Dec 2019 Revised: 4 Jan 2020 Accepted: 15 Jan 2020 Published: 12 Feb 2020
Received: First Decision: Revised: Accepted: Published:
Science Editor: Ming-Lung Yu Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu
Science Editor: Copy Editor: Production Editor: Jing Yu
Abstract

Aim: Patients with chronic hepatitis C virus (HCV) infection who develop hepatocellular carcinoma (HCC) soon
after treatment with direct antiviral agents (DAA) may have been harboring hitherto hidden tumors. If this were
true, they should have a lower sustained viral response (SVR) rate, since active HCC hampers DAA efficacy. We
aimed to verify this hypothesis.

Methods: We included all patients who attended an HCV clinic, provided that they: (1) had no previous history of
HCC; (2) had received at least one DAA dose; and (3) had been followed-up clinically and ultrasonographically for
at least six months after concluding DAA.

Results: The study population included n = 789 patients (55% males, median age 62 years). A median of 9.3 months
(8.8-11.9) after concluding DAA, n = 19 (2.4%) patients were discovered to harbor HCC. In comparison to all others,
patients with HCC were more commonly male (84% vs. 54%, P = 0.009), obese (47% vs. 17%, P = 0.002), and
cirrhotic (95% vs. 35%, P < 0.001) and had less commonly achieved an SVR (68% vs. 98%, P < 0.001). Moreover,
they had a trend for being less commonly treatment naïve (58% vs. 67%, P = 0.051). Based on multivariate analysis,

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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