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pre-existing risk factors for HCC development were treated with DAA. This imbalance would appear to
explain the higher numerical incidence of de novo HCC among DAA-treated patients. Given the success
and cost-effectiveness of DAA therapy for the treatment of HCV infection [47-49] , clinicians should not be
dissuaded by prior studies that suggest an increased risk of precipitating HCC development, as this seems
to largely be a product of the presence of more advanced liver disease and increased risk factors among
DAA-treated patients. Rather, the practice of continued surveillance for HCC for those persons with
baseline risk factors, should continue to be reinforced.

DECLARATIONS
Authors’ contributions
Contributed to the final version of the manuscript: Rutledge SM, Li DK, Chung RT
Performed the statistical analysis: Zheng H
Supervised the project: Chung RT

Availability of data and materials
Not applicable.

Financial support and sponsorship
Raymond T. Chung received grant support (NIH grant DK078772).

Conflicts of interest
All 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) 2019.

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