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Yang et al. Hepatoma Res 2020;6:31 Hepatoma Research
DOI: 10.20517/2394-5079.2019.45

Review Open Access

Impact of direct-acting antivirals on de novo
occurrence of hepatocellular carcinoma in hepatitis

C virus patients

Ming Yang , Ruilan Ma , Yuan Huang , Lai Wei 1
1
1,#
2,#
1 Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China.
2 Department of radiotherapy, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, China.
# Authors contributed equally.
Correspondence to: Prof. Lai Wei, Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University,
No.168 Litang Road, Changping District, Beijing 102218, China. E-mail: weelai@163.com

How to cite this article: Yang M, Ma R, Huang Y, Wei L. Impact of direct-acting antivirals on de novo occurrence of hepatocellular
carcinoma in hepatitis C virus patients. Hepatoma Res 2020;6:31. http://dx.doi.org/10.20517/2394-5079.2019.45

Received: 10 Dec 2019 First Decision: 31 Mar 2020 Revised: 9 May 2020 Accepted: 13 May 2020 Published: 18 Jun 2020

Science Editor: Guang-Wen Cao Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Received: First Decision: Revised: Accepted: Published:
Abstract
Science Editor: Copy Editor: Production Editor: Jing Yu Hepatitis C Virus (HCV) infection constitutes a significant burden to world health, leading to liver cirrhosis and
hepatocellular carcinoma (HCC). In the past decades, pegylated interferon combined with ribavirin has been
used extensively for HCV treatment, and interferon (IFN) is thought to have antitumor property. Direct-acting
antivirals (DAAs) have fundamentally changed HCV therapy, due to their high efficacy and tolerability. However,
recent studies have reported relatively high rates of HCC occurrence, and recurrence, following successful HCV
treatment using DAAs. These studies were grossly underpowered due to their retrospective design, lack of
untreated or IFN controls, small sample size, and limited patient follow-up time. From then, many retrospective
and prospective cohort studies with larger size and longer follow-up duration after DAAs therapy have been
published. These studies showed that treatment with DAAs can reduce the risk of HCC compared to no treatment,
didn’t increase the risk of HCC compared to IFN-based therapy after adjusting for the potential confounders of
these two groups, and DAAs-induced sustained virological response decreased the risk of HCC compared to
DAAs treatment failure. In conclusion, DAAs treatment doesn’t appear to increase the development of HCC, even
in cirrhotic patients. However, cirrhotic patients should be monitored for the development of HCC during and after
DAAs treatment.

Keywords: Sustained virological response, hepatocellular carcinoma, liver cirrhosis

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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