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World J Clin Cases. Feb 26, 2022; 10(6): 1764-1774
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1764
Association between direct-acting antiviral agents in hepatitis C virus treatment and hepatocellular carcinoma occurrence and recurrence: The endless debate
Ahmed Kamal, Ahmed Elsheaita, Mahmoud Abdelnabi
Ahmed Kamal, Internal Medicine Department, Faculty of Medicine Alexandria University, Alexandria 21131, Egypt
Ahmed Elsheaita, Mahmoud Abdelnabi, Clinical and Experimental Internal Medicine Department, Medical Research Institute Alexandria University, Alexandria 21561, Egypt
Mahmoud Abdelnabi, Internal Medicine Department, Texas Tech University Health Science Center, Lubbock, TX 79430, United States
Author contributions: All authors contributed equally to the literature review, data collection, and manuscript writing, and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: Mahmoud Abdelnabi, MD, MSc, Internal Medicine Department, Texas Tech University Health Science Center, 3601 4th St, Lubbock, TX 79430, United States. mahmoud.hassan.abdelnabi@outlook.com
Received: May 16, 2021
Peer-review started: May 16, 2021
First decision: July 27, 2021
Revised: August 5, 2021
Accepted: January 27, 2022
Article in press: January 27, 2022
Published online: February 26, 2022
Processing time: 282 Days and 21.7 Hours
Abstract

Since direct-acting antiviral agents (DAAs) have been introduced into hepatitis C virus treatment, the sustained viral response (SVR) rate has significantly increased to more than 95%. Scientific evidence supports the idea that SVR after interferon therapy has beneficial effects related to cirrhosis progression, resulting in a reduction in the incidence of hepatocellular carcinoma (HCC). However, a significant debate exists related to DAA impact on HCC development. We reviewed the current literature highlighting the controversial data related to DAA association with de novo HCC occurrence or recurrence and possible pathophysiology of HCC related to DAAs. After a review of the published literature, we believe that the current evidence does not confirm or repudiate a higher rate of de novo HCC occurrence or recurrence related to DAA therapy. More trials are needed to determine if there is an association between HCC occurrence or recurrence and DAA or if it is related to preexisting liver cirrhosis.

Keywords: Hepatitis C virus; Sustained virologic response; Direct-acting antiviral drugs; Hepatocellular carcinoma; Liver cirrhosis

Core Tip: Present evidence does not confirm or repudiate a higher rate of de novo hepatocellular carcinoma (HCC) occurrence or recurrence related to direct-acting antiviral agent (DAA) therapy. More trials are required to determine whether there is an association between HCC occurrence or recurrence and DAA or if it is mainly related to preexisting liver cirrhosis.