The risk of hepatocellular carcinoma after sustained virological response in patients treated with the new direct-acting antiviral drugs: should we be worry about it?

Abstract

Hepatocellular carcinoma (HCC) is a serious complication inthe natural history of chronic hepatitis C virus (HCV), andcirrhosis is the strongest risk factor [1]. Although differentrandomized clinical trials [2–4], meta-analyses [5–8], and sys-tematic reviews [9] showed the benefits of interferon (IFN) inreducing the risk of HCC, the achievement of the sustainedvirological response (SVR) did not eliminate this risk. This is aninteresting aspect because if HCV infection is associated withchronic inflammation [10], an effective treatment couldresolve the secondary inflammation and the development ofcomplications. However, Yamashita et al. [11] observed that26% of the patients who had a SVR after IFN therapy devel-oped a HCC (the cumulative rates of HCC were 3.1, 10.1, and15.9% at 5, 10, and 15 years, respectively).