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Harrod et al. Hepatoma Res 2019;5:28 I http://dx.doi.org/10.20517/2394-5079.2019.15 Page 9 of 13

life expectancy may
not benefit from HCV
treatment

Figure 3. Modified from BCLC criteria for treatment of HCC [28] , with considerations for each treatment option outlined beneath

[77]
survival and improve overall survival . Decisions regarding treatment timings should be considered on an
individual basis, taking into consideration the advantages and disadvantages of treatment order [Figure 3].

CONCLUSION
In summary, there is a paucity of clinical data surrounding the co-management of patients with both
active HCV infection and HCC. The guidance for this challenging clinical scenario is to treat patients
on a case-by-case basis, with conflicting evidence as to which condition to treat first. In cases where liver
transplantation may be an option, there are advantages and disadvantages for treating one condition before
the other, which should be considered on a case-by-case basis to enhance patient outcomes depending on
individual clinical factors. Treatment of HCC through LRTs prior to HCV treatment may confer individual
benefit in terms of SVR rates, but viral clearance conversely may improve liver function to allow more
advanced treatment options. Again, assessment on an individual patient basis may be the most appropriate
advice in the absence of robust clinical trials exploring this. For more advanced cases that are only eligible
for systemic therapies, there are interesting parallels in the underlying immune processes that may
have a significant impact on our management, though further trials into this are required before robust
recommendations can be made. With newer treatments rapidly emerging for both conditions, this is an
exciting area of hepatology that no doubt will be at the forefront of research in the coming decade.