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Page 14 of 18 Galicia-Moreno et al. Hepatoma Res 2020;6:20 I http://dx.doi.org/10.20517/2394-5079.2019.36

or vascular invasion when compared to those without DAAs (4/66, 6.1% vs. 17/425, 4%; P = 0.12). A lower
+
incidence of post-transplant HCC recurrence among HCV patients treated with pre- or post-LT DAAs was
observed [0.7%CI (0.2-4.9)]. Although some patients with DAA treatment developed HCC, DAA treatment
was neither associated with increased HCC recurrence after LT nor with waitlist tumor progression [108] .

A prospective, multicenter cohort study was performed in 23 hospitals (from Argentina, Brazil, Chile,
Colombia and Uruguay) from Latin America with 1760 patients treated with DAAs, in order to evaluate
disease progression during a median follow-up of 26.2 months. Results showed an overall, cumulative
incidence of disease progression of 8.3 in non SVR vs. 3.9 after SVR achievement. Disease progression
was seen with the development of liver fibrosis (HR = 3.4; 95%CI: 1.2-9.6), clinically significant portal
hypertension (HR = 2.1; 95%CI: 1.2-3.8) and de novo HCC (HR = 0.2; 95%CI: 0.1-0.8) in the overall cohort.
SVR was associated with an 80% reduction in disease progression when compared with DAA failure, which
supports significant reduction in the risk of new liver-related complications [109] after treatment of HCV
infection with DAAs.

CONCLUSION
HCC is the second leading cause of cancer related-deaths worldwide according to the WHO in 2015. This
global health problem has caused the death of about 1.34 million people. Governments worldwide have
implemented strategies to reduce this mortality but critical issues such as early diagnosis and appropriate
treatment in at risk populations remain to be addressed. In Latin America, it is imperative that clearer
strategies to understand the extent of the problem in this region be implemented. One possible strategy could
be conducting annual epidemiological studies to identify high-risk populations and the main etiological
causes. The updated data might then provide health authorities with more effective preventive approaches
and enable implementation of the most effective treatments on time.

DECLARATIONS
Authors’ contributions
Contributed to the planning, bibliographic revision and writing of the manuscript: Galicia-Moreno M
Contributed to bibliographic revision, figure design, and manuscript writing: Campos-Valdez M, Sanchez-
Meza J
Responsible for the planning of, conducting the study and figure design: Monroy-Ramirez HC
Responsible for manuscript revision: Sanchez-Orozco L
Responsible for manuscript planning and revision: Armendariz-Borunda J
Approved the final manuscript: Galicia-Moreno M, Monroy-Ramirez HC, Campos-Valdez M, Sanchez-Meza
J, Sanchez-Orozco L, Armendariz-Borunda J

Availability of data and materials
Not applicable.

Financial support and sponsorship
Campos-Valdes M and Sanchez-Meza J are members of the CONACYT Doctoral Fellowship Program.
Armendariz-Borunda J is recipient of a CONACYT grant 259096.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.