Characterization of Hepatocellular Carcinoma Following Direct-Acting Antiviral Therapy: A Prospective Study

Background and aim: Chronic Hepatitis C (CHC) remains the most common cause of Hepatocellular Carcinoma (HCC). Direct-Acting Antiviral (DAA) therapy reduce incident of HCC among HCV-infected patients, however the impact of these therapies on tumor behavior is less clear. Here, we compared the characteristics of HCC diagnosed before and after initiation of f DAA therapy in large population-based cohort. Patients and methods: In a prospective cohort of an outreached program in 73 villages across Egypt, 14,495 (91.2%) patients were treated with DAAs and followed after SVR for median of two years (12-45 months), Of those, 275 patients had HCC (166 patients before and 109 patients after the initiation of DAA therapy). Results: Patients who developed HCC after DAA had less tumor size, portal vein invasion, advanced stage according to BCLC classification and Milan criteria compared to those who developed HCC before therapy (P<0.05, for all comparisons). These findings remained significant independent of age, sex, body mass index (BMI), AFP, viral load and Child-Pugh score (Odds ratio: 0.338; 95% confidence interval: 0.13-0.366; P=0.0001). Conclusion: HCC developed in CHC patients who achieved SVR following DAAs tend to display less aggressive pattern when compared to HCC diagnosed before DAAs therapy.