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Rewisha et al. 16 case series of HCC post DAAs

risk of developing de novo HCC and a relatively low treatment (4.19 ± 3.48 months). The focal lesions were
risk for HCC recurrence. [5] mainly cited in the right hepatic lobe (62.5%), 12.5% in
the left lobe while multi-focal lesions were detected in
Amelioration of HCV natural history is the anticipated 4 cases (25%) [Table 1].
post treatment target. Sustained virological responses
(SVR) and their link to lessened HCV-related morbidity Malignant portal vein thrombosis was radiologically
and mortality, including HCC had been interrogated documented in 1 patient (6.25%). Significant
since the era of IFN-containing regimens. This biochemical derangements were reported following
[6]
conception has been already recalled in the new era of revelation of HCC. They were significant enough to
DAAs with evolving comparable perspectives. This is transfer most of the affected patients from Child class
[7]
the first report from Egypt; registering 16 primary HCC A to Child C cirrhosis [Table 2].
cases respective to DAAs therapy.
Statistical analysis
CASE REPORT Statistical analysis was carried out using SPSS
(Statistical Package for Social Science) program.
This report includes a series of 16 patients who were Data was entered as numerical or categorical, as
diagnosed as Child A HCV-related cirrhosis. They appropriate. Quantitative data was shown as mean,
presented to National Liver Institute Hospital, Menofia and SD, while qualitative data has been expressed as
University, Egypt, to receive care and management frequency and percent.
as inpatients in the Clinical Hepato-Gastroenterology
Department. DISCUSSION

The patients were males except for 1 female and at Obviously, sofosbuvir is the principal DAA in the current
their late fifties. They were diagnosed as having HCV case series and all published reports of HCC connected
infection during the least 4 years. Pre DAAs treatment to DAAs. However, the alleged link between DAAs in
[8]
evaluation, laboratory, endoscopic as well as tedious general, sofosbuvir or sofosbuvir related metabolites
professional abdominal imaging [either abdominal and carcinogenesis needs to be analyzed. Several
ultrasound or computerized tomography (CT) scan] theories were hypothesized to explain this proposed
were available for all patients. linkage; however, none of them had a robust proof

All patients received IFN-free, sofosbuvir-based Table 1: Descriptive demographic and bibliographic
regimens. Sofosbuvir plus ribavirin was prescribed to data of the studied patients (n = 16)
11 cases (68.8%), sofosbuvir/daclatasvir plus ribavirin Studied variables Mean SD
were given to 3 patients (18.8%), 1 patient was given Age (years) 56.63 6.79
sofosbuvir plus daclatasvir (6.2%), and 1 patient (6.2%) Duration of HCV infection (years) 8.69 4.64
had received sofosbuvir plus simeprevir. SVR at week Timing of HCC presentation post 4.19 3.48
treatment (months)
12 post treatment was achieved in 13 cases (81.25%). Gender Number Percent
Males 15 93.8
The patients had completed their treatment regimens, Females 1 6.2
except 2 cases that developed drug-related HCV genotyping All cases were
genotype 4a
complications, and stopped the treatment. Only 1 Site of lesion(s) by ultrasound
relapse was reported in this study group. Right 10 62.5
Left 2 12.5
Multifocal 4 25.0
The newer sonography and CT imaging in 2 cases Size of the lesion(s) (cm)
as well as the remaining 14 patients had surprisingly Less than 3 12 75.0
unveiled presence of predominantly small HCC. The 3-5 3 18.8
6.2
1
More than 5
small-sized lesions added to the mean timing for HCC Virological responses
detection (4.19 ± 3.48 months post-treatment), and End of treatment 14 87.5
the pre-treatment compensated liver disease have Sustained responders 13 81.3
Relapsers
6.2
1
suggested HCC occurrence rather than a continuation Incomplete course 2 12.5
of pre-treatment lesions. The DAAs’ regimens
Sofosbuvir + ribvirin 11 68.8
6.2
Most of these new lesions were small; less than 3 cm Sofosbuvir + simprevir 1 18.8
3
Sofosbuvir + daclatasvir
in 12 patients (81%), 3-5 cm in 3 cases (18.8%), while Sofosbuvir + daclatasvir + ribvirin 1 6.2
1 patient who was diagnosed with a lesion more than 5 HCV: hepatitis C virus; HCC: hepatocellular carcinoma; DAA:
cm. All these patients presented less than 1 year post- direct-acting antiviral
Hepatoma Research ¦ Volume 3 ¦ August 11, 2017 179