Topic: The Interplay between Direct-Acting Antivirals and Hepatocellular Carcinoma in Chronic Hepatitis C

Chronic hepatitis C (CHC) infection is one of the major etiologies of hepatocellular carcinoma (HCC). As with the observations in the interferon era, treating patients with directly acting antivirals significantly reduces HCC risk. However, the risk ratio reduction may be more limited in patients who already possess decompensated liver cirrhosis. In terms of HCC recurrence, it has been suggested that HCC may recur more frequently and aggressively after DAA intervention. The difficulty in performing a prospective study comparing to non-treatment cohort may render inconclusive results. The issue of washout period between curative HCC treatment and initiating DAA treatment may also determine the interpreting of the outcomes. With more evidence emerging, the HCV eradication by DAA should not have a negative impact on HCC recurrence.
From another perspective, whether the presence of active HCC would compromise DAA treatment efficacy remains an area of uncertainty. The discrepant results may arise from diverse patient characteristics and treatment regimens. The long-term survival benefit of HCV eradication in patients with active HCC remains to be studied. In this issue, the interaction between DAA and HCC will be reviewed.