The impact of treatment of hepatitis C with DAAs on the occurrence of HCC

Abstract

Hepatitis C virus infection is a major cause of chronic hepatitis resulting in cirrhosis and hepatocellular carcinoma (HCC). The recent introduction of direct acting antivirals (DAA), results in sustained virological response (SVR) rates of >90% in treated patients whatever the stage of liver fibrosis with an excellent safety profile. This major advancement has allowed treatment of a larger number of patients, some with more advanced liver dysfunction and a higher risk of HCC. An SVR is associated with a reduced risk of hepatic decompensation, the need for liver transplantation and both liver‐related and overall mortality. This high rate of SVR has raised hopes that there would be a significant reduction in the incidence of HCC. However, the impact of DAA‐based regimens on the occurrence of HCC in patients with cirrhosis, and in particular the recurrence of HCC following successful curative treatment is controversial. Published studies suggest that DAA does not increase the risk of de novo HCC following SVR. A more controversial topic is the effect of a DAA‐based SVR on the recurrence of HCC following curative treatment of early HCC. Well‐designed studies with robust comparisons are needed to determine the effect of DAA on the recurrence of HCC. At present, patients with HCV cirrhosis who have undergone resection or ablation for HCC should not be dissuaded from receiving DAA therapy to prevent the progression of liver disease. Monitoring for HCC with liver imaging and AFP should be performed twice a year indefinitely post‐SVR in patients with HCV cirrhosis.

 

KEYWORDS
cirrhosis, direct acting antivirals, hepatitis C, hepatocellular carcinoma

 

About Speaker

Didier SAMUEL

Professor Didier Samuel / Dean of the Faculty of Medicine Paris Sud / Head of the Liver and Intensive Care Units / Director of Inserm Research Unit 1193 / Medical Director of the Liver Transplant Program

France

City: Villejuif

Institution: Centre Hepatobiliaire - Hôpital Paul Brousse - Groupe Hospitalier Paris Sud - DHU Hepatinov

Contact: didier.samuel@pbr.aphp.fr


Biography of Didier SAMUEL

Dr. Didier Samuel, MD, PhD, is Professor of Hepatology and Gastroenterology at Université Paris-Sud, Villejuif, France. Prof Samuel is also Medical Director of the Liver Transplant Program, and Head of both the Liver and Intensive Care Units at Centre Hepatobiliaire of Universitary Hôpital Paul Brousse in Villejuif. He was Head of the Departments of Diseases of the Liver and of Digestive and Urinary Systeme at Paris Sud Universitary Hospitals from 2011 to 2017. In addition, he is Director of Inserm Research Unit 1193 at Université Paris Sud. Prof Samuel obtained his MD in 1985 and his PhD in 1994 from Université Paris-Sud, and served his internship at Hôpitaux de Paris. He is currently Dean of the Faculty of Medicine Paris Sud. His research focuses on liver transplantation, viral hepatitis, HIV, liver failure and hepatocellular carcinoma. He is a member of the Council of the International Liver Transplantation Society (ILTS, acting as President 2013-2014), the American Association for the Study of Liver Diseases (AASLD), and European Association of the Study of the Liver (EASL, he was member of the Scientific Committee 2000-2003). He served as Editor-in-Chief of Journal of Hepatology (2010-2014). Prof Samuel has published over 400 articles in peer-reviewed scientific journals and textbooks, with a H-index of 66 and has given over 300 lectures at international congresses. In 2007, he was honored with the AASLD Achievement in Liver Transplantation Award. In 2010 he was awarded in France with the Legion d’Honneur and in 2014 with the Research Prize Allianz-Fondation de France.

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