Direct-Acting Antiviral Drugs and Occurrence of Hepatocellular Carcinoma: Unjust or Oppressed

Abstract

Sahar M Hassany,1 Wesam Hassan,2 Hany Abo-alam,2 Marwa Khalaf,2 Amany M Nafeh,3 Eman Nasr-eldin,4 Ehab F Mostafa1 1Tropical Medicine and Gastroenterology Department, Alrajhi University Hospital, Assiut University, Assiut, Egypt; 2Hepatology Centre, Ministry of Heath, Assiut, Egypt; 3Microbiology and Immunity Department, Assiut University, Assiut, Egypt; 4Clinical Pathology Department, Assiut University, Assiut, EgyptCorrespondence: Sahar M HassanyAlrajhi University Hospital, Assiut University, Assiut, EgyptTel [phone]Fax [phone]Email [email protected]: In interferon-free era, direct-acting antiviral agents (DAAs) have achieved high eradication rates with an excellent safety profile since revolutionized the management of hepatitis c virus (HCV) patients. Published papers have suggested a possible increased incidence of hepatocellular carcinoma (HCC) after successful DAAs treatment. Other papers have been published about the problem but without conclusive results. Because of this debate, we aim to evaluate the effects of antiviral therapy (Sofosbuvir plus Daclatasvir with or without Ribavirin) on the de novo occurrence of HCC in patients with liver cirrhosis (LC).Patients and Methods: A prospective cohort study has included 350 patients who have visited our center for HCV treatment. Pretreatment history, examination, complete blood picture, liver function tests, kidney function tests, HA1C for diabetic patients, HCV PCR, HBsAg, alpha-fetoprotein (AFP), and abdominal ultrasound have been done, also Child-Pogh (CP) and Model for End-Stage Liver Disease (MELD) score before treatment. These investigations have been repeated for 3 months after the end of treatment. Abdominal ultrasound (US) has been done for 3 months after treatment and every 4 months for 2 years after the end of treatment to detect HCC occurrence.Results: Patients age (58.11 ± 7.48), 55.4% of patients were males, 30.3% of patients were diabetic, 84.3% of them were treatment naïve and sustained virological response (SVR) occured in 94% of them. HCC occurrence after treatment was 6.7% in patients with SVR and 23.8% in patients with non-SVR (P value=0.016) during follow-up period. There is significant improvement of CP score. No significant changes in MELD score.Conclusion: Treatment of HCV-related LC patients with sofosbuvir and daclatasvir with or without ribavirin for 3 or 6 months showed high SVR and significant improvement in CP score, but still at risk of HCC even if treated and should be followed up regularly according to screening programs with special meticulous attention to those with non-SVR.Keywords: de-novo HCC occurrence, HCV treatment

Keywords

• de-novo hcc occurrence
• hcv treatment