Hepatocellular Carcinoma in Hcv Cirrhosis after Viral Clearance with Direct Acting Antiviral Therapy: Preliminary Evidence and Possible Meanings

Corresponding Author: Luca Rinaldi, MD; [email protected] Abstract – Background and AIM Hepatocellular carcinoma (HCC) is a frequent complication of HCV liver cirrhosis. The reduction of risk after the clearance of HCV-RNA is debated. The aim of our study was to detect the appearance of HCC during the follow-up after antiviral treatment with direct acting antiviral therapy. Patients and Methods: In four specialist Centers, 280 HCV patients were analyzed. The choice of the regimen was based on genotype and stage of liver disease. Abdomen ultrasonography was performed prior, at the end of therapy, and after six months. Biochemistry, BMI, presence of comorbidity, and any complications of related to cirrhosis were also evaluated. Results: Nine HCC were found by ultrasonography (5 cases at the end of therapy, 4 cases 3 months after the end of follow-up); in all cases, HCC was confirmed by a second level imaging examination (computed tomography or magnetic resonance). Characteristics of patients were: male (66.9%; range 56-77), BMI (median 25.4; range 21-40). Prevalence of diabetes was 55.2%. Genotypes were: 1b (6 patients), 1a (2 patients), 2a/2c (1 patient). The therapies were: sofosbuvir plus simeprevir (1 patient), sofosbuvir plus simeprevir plus ribavirin (2 patients), sofosbuvir plus daclatasvir plus ribavirin (2 patients), sofosbuvir plus ribavirin (2 patients), Viekirax + Exviera plus ribavirin (2 patient). One patient only experienced a viral relapse at week 12 after the end of therapy. The incidence of HCC was 3.2%. Conclusions: In patients with liver cirrhosis, even if HCV replication stops, a close follow-up with ultrasonography is mandatory. Since the cumulative incidence is high, a greater sample size is necessary to clarify if the interferon-free antiviral therapy had an influence on the onset of HCC.