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World J Hepatol. Mar 27, 2022; 14(3): 525-534
Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.525
Safety of direct acting antiviral treatment for hepatitis C in oncologic setting: A clinical experience and a literature review
Anna Maria Spera
Anna Maria Spera, Infectious Disease Unit, Universitary Hospital OO RR San Giovanni di Dio e Ruggi d'Aragona, Salerno 84131, Italy
Author contributions: Spera AM studied conception and design; data collection; analysis and interpretation of results; draft manuscript preparation; Spera AM finally reviewed the results and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anna Maria Spera, MD, PhD, Doctor, Infectious Disease Unit, Universitary Hospital OO RR San Giovanni di Dio e Ruggi d'Aragona, Largo Ippocrate, Salerno 84131, Italy. annamariaspera@hotmail.it
Received: November 25, 2021
Peer-review started: November 25, 2021
First decision: December 27, 2021
Revised: January 11, 2022
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: March 27, 2022
Processing time: 118 Days and 19.8 Hours
Abstract

With a globally estimated 58 million people affected by, chronic hepatitis C virus (HCV) infection still represents a hard challenge for scientific community. A chronic course can occur among patients with a weak innate ad adaptive response with cirrhosis and malignancies as main consequences. Oncologic patients undergoing chemotherapy represent a special immunocompromised population predisposed to HCV reactivation (HCVr) with undesirable changes in cancer treatment and outcome. Aim of the study highlight the possibility of HCVr in oncologic population eligible to chemotherapy and its threatening consequences on cancer treatment; underline the importance of HCV screening before oncologic therapy and the utility of direct aging antivirals (DAAs). A comprehensive overview of scientific literature has been made. Terms searched in PubMed were: “HCV reactivation in oncologic setting” “HCV screening”, “second generation DAAs”. Pharmacokinetic and Pharmacodynamics characteristics of DAAs are reported, along with drug - drug interactions among chemotherapeutic drug classes regimens and DAAs. Clinical trials conducted among oncologic adults with HCV infection eligible to both chemotherapy and DAAs were analyzed. Viral eradication with DAAs in oncologic patients affected by HCV infection is safe and helps liver recovery, allowing the initiation of cancer treatment no compromising its course and success.

Keywords: Hepatitis C Virus; Direct aging antivirals; Drug interactions; Pharmacodynamic; Pharmacokinetic; Pre-emptive therapy

Core Tip: Chronic hepatitis C virus (HCV) infection is a hard clinical challenge, especially regarding oncologic patients eligible to chemotherapy. HCV reactivation in this setting of population is due to iatrogenic immunosuppression and can impair cancer treatment and outcome. Several specialists still do not prescribe direct aging antivirals to oncologic patients affected by HCV infection, because no univocal guidelines on HCV treatment in oncologic setting are available. The review highlights the importance of screening HCV infection before starting oncologic treatment, the safety of direct aging antivirals treatment under chemotherapy and the utility of treating HCV infection in oncologic setting no compromising chemotherapy course and success.