Published online Dec 27, 2018. doi: 10.4254/wjh.v10.i12.898
Peer-review started: September 13, 2018
First decision: October 5, 2018
Revised: November 8, 2018
Accepted: November 15, 2018
Article in press: November 16, 2018
Published online: December 27, 2018
The introduction of a direct-acting antiviral (DAA) for patients with hepatitis C virus (HCV) infection, could lead to higher sustained virologic response (SVR) rates with fewer adverse events, and it could shorten the treatment duration relative to the interferon era. Although most recent clinical studies have demonstrated that the occurrence rates of hepatocellular carcinoma (HCC) are decreased by SVR with both interferon-based and interferon-free-regimens, there are several reports about the unexpected observation of high rates of early tumor occurrence and recurrence in patients with HCV-related HCC undergoing interferon-free therapy despite SVR. Several mechanisms of HCC occurrence and rapid immunological changes, including cytokines and chemokines during and after DAA treatment, have also been reported. We focused on the possibilities that HCC occurs or recurs during and after DAA treatment, based on the reported clinical and basic studies. Further studies and observations will be needed to determine the short-term and long-term effects on hepatocarcinogenesis caused by the eradication of HCV with DAAs. New serum biomarkers and a follow-up system for HCV-patients with SVR should be established.
Core tip: The incidence of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) patients with sustained virologic response (SVR) after direct-acting antiviral (DAA) treatment is a serious health issue. We focused on the role of DAA treatment in hepatocarcinogenesis. DAAs may also lead to rapid changes in immune status through interactions between the host and HCV. Changes in the immune system may play a role in the progression of HCC. Further observations are needed to determine the effects on hepatocarcinogenesis caused by the eradication of HCV with DAAs.