Direct acting antivirals for hepatitis c and hepatocellular carcinoma recurrence: an unsolved mystery

With the development of direct acting antivirals (DAA), we have seen a significant improvement in outcomes in treatment of hepatitis C. DAAs have provided an effective, well tolerated treatment for hepatitis C in patents with cirrhosis (1). With the high success rates of DAAs, the medical community was hopeful that this would translate to decreased hepatocellular carcinoma (HCC) recurrence rates. Achieving sustained viral response (SVR) with interferon (IFN) based treatment regimens has been shown to decrease the risk of recurrence of HCC, and thus there was hope for similar effects with DAAs (2). However, several studies have shown unexpectedly high rates of recurrence of HCC in the early post DAA treatment time period.