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outcomes. Even if the clinical significance of these findings needs to be confirmed in additional prospective
studies, these data corroborate the hypothesis of a different biologic pathway in the neoplastic process
leading to HCC after DAA treatment.

CONCLUSIONS
In this review, we have analysed the published data on the risk of developing HCC after DAA therapy.
Even if definite conclusions cannot be probably drawn, there is sufficient evidence to summarize the most
important findings: (1) direct antiviral therapy does not seem to increase the cumulative annual rate of HCC
de novo occurrence or recurrence; (2) direct antiviral therapy seems to accelerate the development of HCC,
soon after the end of treatment, in those patients at higher risk of HCC occurrence or recurrence; and (3)
preliminary reports seem to indicate that HCC developed after direct antiviral therapy has more aggressive
features. These findings clearly indicate the need for aggressive and close monitoring of cirrhotic patients
during and after antiviral treatment, to detect and treat HCC at their earliest occurrence.

DECLARATIONS
Authors’ contributions
Both authors equally contributed to ideation and conduction of the review.

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Not applicable.

Ethics approval
Not applicable.

Copyright
© The Author(s) 2018.

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