Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2018; 10(2): 267-276
Published online Feb 27, 2018. doi: 10.4254/wjh.v10.i2.267
Impact of direct acting antivirals on occurrence and recurrence of hepatocellular carcinoma: Biologically plausible or an epiphenomenon?
Amna Subhan Butt, Fatima Sharif, Shahab Abid
Amna Subhan Butt, Fatima Sharif, Shahab Abid, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
Author contributions: All authors have contributed to the study concept, manuscript writing, editing and approval of the final manuscript for publication.
Conflict-of-interest statement: No conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Shahab Abid, FACG, FCPS, MD, PhD, Professor, Section of Gastroenterology at Department of Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
Telephone: +92-21-34930051 Fax: +92-21-34932095
Received: November 28, 2017
Peer-review started: December 5, 2017
First decision: January 15, 2018
Revised: February 6, 2018
Accepted: February 9, 2018
Article in press: February 9, 2018
Published online: February 27, 2018
Core Tip

Core tip: Our aim is to consolidate the existing literature as well as to identify whether there is a particular subset of the population in which this phenomenon was witnessed. The ground-breaking discovery of the new group of direct acting antiviral agents (DAAs) had led to a paradigm shift in the management of chronic hepatitis C (CHC). Wide variations have been observed in the studies assessing the long-term role of DAA based therapy on occurrence and recurrence of HCC. There is a need to differentiate weather the reported higher occurrence and recurrence rates are due to DAA or host and disease related factors and to identify subset of individuals particularly at risk. Also, future investigations should be directed towards assessing the long-term effects of DAAs on group of patients that have not been studied thus far. Some important Centers in Europe and United States have been delaying antiviral treatment for 6 mo or more after the recent treatment for HCC. Hence, until more robust data is available, clinical practices should continue as per current guidelines in those patient groups who can benefit from DAA therapy with close surveillance of patients with advance fibrosis.