الفهرس 
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Abstract
HCV infection is a major cause of chronic hepatitis resulting in cirrhosis and HCC. When cirrhosis is present, the annual incidence of HCC is 3%- 7%.
In the last few decades, hepatologists have been focused on developing safe and effective treatments for hepatitis C virus infection. The interferon-based therapy period was marred by problems and a high frequency of serious adverse events necessitating close monitoring and follow-up, while sustained virologic response rates were often not very high.
The introduction of DAAs therapy that directly inhibited the HCV replication cycle has resulted in a dramatic improvement in HCV treatment in recent years. Direct-acting antivirals target three key regions of the HCV genome: the NS3/4A protease, the NS5A, and NS5B RNA-dependent polymerase. These drugs have higher SVRs than interferon-based regimens, take less time to treat, are taken orally, and have fewer side effects.
The effect of DAAs-based regimens on the occurrence of HCC in cirrhotic patients, and its recurrence after successful curative treatment, is, debatable. The majority of reports are based on single-center, retrospective observational studies with varying patient characteristics and follow-up periods. As a result, the picture remains hazy for the time being, with significant heterogeneity.
The main objective of this study was to detect the occurrence and recurrence of HCC during the follow-up after antiviral treatment with direct-acting antiviral therapy in patients with chronic HCV infection and in patients with chronic HCV prior history of treated hepatocellular carcinoma who achieved complete response.
302 patients with chronic hepatitis C virus infection without prior history of HCC ( group A) and 128 patients with chronic hepatitis C virus infection with prior history of treated hepatocellular carcinoma by ablation or resection ( group B). group A included 152 patients who received DAAs and followed for at least one year and 150 patients who received interferon between 2012 to 2014 who retrospectively analyzed.
group B included 63 patients who were treated with direct-acting antivirals and 65 were not received DAAs and followed for at least one-year duration.
The study’s main findings are that DAAs use in chronic HCV patients with advanced fibrosis and compensated cirrhosis is not related to an increased risk of HCC and has no significant difference when compared to those who received IFN treatment and that among those who developed HCC, DM and increased liver stiffness (measured by fibroscan) are independent risk factors for the occurrence of HCC in DAAs exposed patients.
In patients with a previous history of cured HCC, DAAs use was linked to an increased risk of recurrence, but there was no significant difference when compared to those who did not receive HCV infection treatment, and that among those who developed recurrent HCC, increased severity of liver cirrhosis as measured by Child-Pugh score, increased liver stiffness as measured by fibroscan and use of DAAs are independent risk factors for recurrence of HCC after use of DAAs.
Conclusions
The current study support that the occurrence of HCC is reduced in chronic hepatitis C patients with advanced fibrosis and liver cirrhosis after DAAs treatment, DM and increase liver stiffness are independent risk factors for HCC occurrence in those patients.
DAAs do not increase the recurrence of HCC after curative treatment but also do not decrease it with increased Child classification, increased liver stiffness, and use of DAAs are independent risk factors for HCC recurrence.
RECOMMENDATIONS
Further studies on a large geographical scale and larger sample size.
Risk assessment for HCC should be rigorously undertaken before DAAs, and those at risk should have attentive surveillance during treatment and afterward.
For people at risk, it is noteworthy to explain the importance of continued surveillance after HCV eradication.
Physicians in the outreach clinics should know that in HCV-positive patients, the risk of HCC is reaching higher figures compared with those who eliminated the virus, yet sustained responders having advanced fibrosis are still at high HCC risk.
It may be appropriate to use DAA therapy after HCC treatment, but only after a full response has been verified for at least 6 months.
Whenever possible, antiviral treatment should be started early, before the development of liver cirrhosis.