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Hepatitis C Antiviral Therapy In Patients With Successfully Treated Hepatocellular Carcinoma: Dancing With Wolves

Authors El Kassas M, Tawheed A, Eltabbakh M, Kaseb A

Received 25 February 2019

Accepted for publication 21 October 2019

Published 19 November 2019 Volume 2019:6 Pages 183—191

DOI https://doi.org/10.2147/JHC.S206668

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Aldo Lourenço Abbade Dettino


Video abstract presented by Mohamed El Kassas.

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Mohamed El Kassas,1 Ahmed Tawheed,1 Mohamed Eltabbakh,2 Ahmed Kaseb3

1Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt; 2Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 3Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

Correspondence: Mohamed El Kassas
Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
Tel +20 111 445 5552
Fax +20227239227
Email m_elkassas@yahoo.com

Abstract: Hepatitis C virus (HCV) infection is known to be one of the leading causes of hepatocellular carcinoma (HCC) all over the world. Previously, multiple studies have confirmed a decreased rate of HCC occurrence or recurrence in the cases of hepatitis C associated cirrhosis after treatment with interferon, in comparison to the untreated cases, even in the absence of clearance of HCV. Treatment programs with direct-acting antivirals (DAAs) as a new method for HCV treatment and cure in 2014, with higher safety and efficacy, were considered as an important step in the treatment of patients with history of HCC, improving their overall prognosis. Recently, reports coming from various European centers claimed that the risk of HCC increased following DAAs therapy, especially in cases with previous HCC. Moreover, other studies revealed that the recurrence of HCC after DAAs treatment was more aggressive. Even though others were not able to conclude the same results, the role of DAA therapy in recurrence of HCC in patients with previous HCC after sustained virological response (SVR) achievement remains questionable. This review explored the existing literature and discussed opinions on the possibility of increasing recurrence of HCC following DAA therapy, possible mechanisms, predictors of HCC recurrence post DAAs, and whether those patients should be treated or not.

Keywords: hepatitis C virus, hepatocellular carcinoma, recurrence, direct-acting antiviral agents

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