Antiviral Therapy in Patients with Viral Hepatitis and Hepatocellular Carcinoma: Indications and Prognosis

Abstract

Background: Chronic hepatitis B and C infections represent major risk factors for the development of hepatocellular carcinoma (HCC). Recently, the management of patients with viral hepatitis has dramatically changed. In the present review we discuss the impact of these developments on the prevention of HCC as well as the treatment of patients with HCC. Methods: Studies indexed in Medline between 1990 and 2015 (November) were reviewed. The terms ‘hepatocellular carcinoma', ‘HCC', ‘hepatitis B', ‘hepatitis C', ‘viral hepatitis', and combinations of these terms were used. Results: Patients with chronic hepatitis B or hepatitis C without HCC should be evaluated for antiviral therapy, since antiviral therapy was suggested to reduce the risk of HCC development. Cirrhotic patients infected with hepatitis B virus (HBV) require antiviral therapy, while cirrhotics infected with hepatitis C virus (HCV) need to be prioritized for therapy with interferon (IFN)-free regimens. Antiviral therapy should be considered in HBV-infected patients with HCC, especially to prevent tumor recurrence after curative-intended therapy or to prevent hepatic decompensation. HCV-infected patients with HCC should be considered in similar intention for IFN-free antiviral therapy, depending on the tumor stage and life expectancy. Conclusion: Patients with viral hepatitis should be considered for antiviral treatment for the prevention of HCC development as well as during HCC treatment.

Genetic biomarkers for hepatocellular cancer risk in a caucasian population

“…Those improvements might facilitate early cancer detection and might lead to potentially curative therapies. Furthermore, an enhanced understanding of the genetic factors associated with the evolution of HCV infection could be essential for the optimized use of the recently developed, but highly expensive, anti-HCV DAAs[ 12 , 13 ]. Thus, improved screening could assist the health care system in containing costs and ensuring the most clinically appropriate treatments.…”

“…In some countries, including the United States and Europe, HCV-related HCC accounts for most liver cancer incidents[ 11 ]. Consequently, an increased understanding of the genetic contribution to the clinical course of viral infection could be essential in optimizing the use of newly developed, but highly expensive, direct acting antiviral (DAA) treatments[ 12 , 13 ].…”

UGT1A polymorphisms as genetic biomarkers for hepatocellular carcinoma risk in Caucasian population

“…The novel identified UGT1A markers, in combination with other well‐known serum biomarkers (eg alphafetoprotein) and diagnostic imaging (eg ultrasonography), could contribute to improving HCC risk stratification algorithms and surveillance programmes both in patients already at risk (HBV/HCV‐positive) and in the general population, thereby allowing early cancer diagnosis and possible curative therapy. Specifically, for HCV‐infected patients, these risk factors could be considered as selection criteria for a more personalized use of antiviral therapies that were demonstrated to attenuate the risk of tumour development . Particularly, an enhanced understanding of the genetic factors associated with the clinical course of specifically HCV infection could be essential for an optimized use of the recently developed and highly expensive direct‐acting antivirals, helping the healthcare system in containing costs and ensuring the most clinically appropriate treatment.…”

Statin and the risk of hepatocellular carcinoma in patients with hepatitis B virus or hepatitis C virus infection: a meta-analysis

“…Patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection are primarily the high-risk population for the development of HCC [2][3][4]. Although HBV suppression or HCV eradication has been increasingly applied, the incidence of HCC in patients with HBV or HCV infection remains high [5,6]. Therefore, identification of novel chemoprevention agents for HCC remains of great clinical importance, particularly for high-risk population such as patients with HBV or HCV infection [7].…”