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Lee et al. Hepatoma Res 2020;6:21 Hepatoma Research
DOI: 10.20517/2394-5079.2019.44

Review Open Access

The impact of direct-acting antivirals on hepatitis C
associated hepatocellular carcinoma

Tai-Ping Lee, David Bernstein

Division of Hepatology and Sandra A. Bass Center for Liver Diseases at Northwell Health, Manhasset, NY 11030, USA.
Correspondence to: Dr. Tai-Ping Lee, Division of Hepatology and Sandra A. Bass Center for Liver Diseases at Northwell Health,
Manhasset, NY 11030, USA. E-mail: taiplee@gmail.com

How to cite this article: Lee TP, Bernstein D. The impact of direct-acting antivirals on hepatitis C associated hepatocellular
carcinoma. Hepatoma Res 2020;6:21. http://dx.doi.org/10.20517/2394-5079.2019.44

Received: 17 Dec 2019 First Decision: 26 Feb 2020 Revised: 8 Apr 2020 Accepted: 10 Apr 2020 Published: 11 May 2020
Science Editor: Ming-Lung Yu Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
The increased incidence of hepatocellular carcinoma (HCC) in the last several decades in the United States
and worldwide has partly resulted from an increase in hepatitis C virus (HCV) infection. HCV carcinogenesis is
speculated to be indirectly related to multiple steps from inflammation to fibrosis and advanced fibrosis/cirrhosis
over 20 or more years. However, the direct carcinogenic potential from HCV may explain HCC occurring in non-
cirrhotic HCV patients. Highly potent direct-acting antivirals (DAAs) in recent years have changed hepatitis C
treatment significantly and have resulted in the sustained virologic response (SVR) rate exceeding 90%. Although
initial reports concerned the increase in de novo and recurrent HCC associated with DAAs, more recent studies
showed that DAA-induced SVR on the contrary reduced risk of HCV-associated HCC without increasing its
recurrence. The International Consortium of Hepatitis C Therapeutic Registry and Research Network (HCV-
TARGET) database and other resources of HCV patients treated with DAA collectively in the near future most
likely will be able to show definitive evidence on the risk of HCC occurrence and recurrence after DAA with
SVR. The long-term risk of HCC in chronic hepatitis C patients with advanced fibrosis or cirrhosis remains high
after DAAs with SVR. Thus, HCC surveillance on this sub-group of patients is important for early detection and
intervention of HCC.

Keywords: Direct-acting antivirals, hepatitis C virus infection, risk of hepatocellular carcinoma

INTRODUCTION
Liver cancer was predicted to be the sixth most commonly diagnosed cancer and the fourth leading cause of
cancer death worldwide in 2018. Statistically, hepatocellular carcinoma (HCC) comprises 75%-85% cases of
[1]
liver cancer .

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