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Page 12 of 18 Alqahtani et al. Hepatoma Res 2020;6:58 I http://dx.doi.org/10.20517/2394-5079.2020.49

after therapy experienced a late HDV relapse [163] . Interestingly, these late relapses were not associated with
clinical complications. This might indicate that a prolonged virologic response to pegylated IFN-α, even if
not sustained, can be clinically relevant in patients with chronic hepatitis D [163] .

CONCLUSION
Blood-borne viral hepatitis is a dominant cause of HCC worldwide, and the positive effect of their
eradication on the risk of developing HCC has been extensively demonstrated even in patients carrying
significant metabolic comorbidities that predispose them to the neoplastic transformation of the liver.
Along this line, intriguing data have emerged, suggesting a significant chemoprophylactic activity of liver
metabolism modifiers such as statins and aspirin. All in all, the implementation of articulated interventions
of sanitation make reaching the WHO goal of viral elimination more realistic in some small countries
like Georgia or Iceland, where elimination programs can easily be run, than in large countries where it
is difficult even to identify hepatitis carriers. Further mitigating our belief of being on the right track for
global elimination of viral hepatitis was the increasing hesitance against hepatitis B vaccination. In recent
years, it has amounted to the level of reaching an alarming proportion of 30% in many high-income
countries. While this could be counteracted by the recent pandemic of 2019 coronavirus disease (shortly,
COVID-19) that has restored confidence in public health policies based on vaccination, another critical
point in the fight against viral HCC is the existence of awareness campaigns and screening programs, since
the first essential step in the viral hepatitis cure pathway is to be aware of the infection. Identification of
defined risk cohorts, including baby-boomers, people who inject drugs, prisoners, and men who have sex
with men, improves the cost-effectiveness of screening programs aimed to target infected populations;
however, determining the infectious status is irrelevant if effective linkage-to-care programs are not in
place. The availability of generic antivirals can partially overcome the bottleneck represented by the lack of
resources in low and middle-income countries where HBV and HCV prevail as risk factors for HCC.

DECLARATIONS
Authors’ contributions
Equally made substantial contributions to the conception and design of the study and performed data
analysis and interpretation: Alqahtani SA, Colombo M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

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

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.