Direct acting antiviral agents and hepatocellular carcinoma development: don’t take it for granted

Buonomo, Antonio Riccardo; Gentile, Ivan; Borgia, Guglielmo

doi:10.21037/tgh.2017.11.09

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…In patients with cirrhosis, several factors are associated with a higher risk of developing HCC, for instance, co-infection with hepatitis C virus (HCV)/human immunodeficiency virus (HIV)/hepatitis B virus (HBV), obesity, steatosis, diabetes mellitus, and alcohol abuse (4)(5)(6)(7). The interest in new factors potentially involved in the occurrence of HCC increased recently due to evidence that some patients with chronic HCV infection may show a de novo occurrence of HCC during or after treatment with new directly acting antiviral agents, despite their high efficacy in curing viral infection (8)(9)(10)(11). In fact, new anti-viral treatments for HCV are able to reach very high rates of viral eradication with scarce side-effects differently from previous antiviral treatments for HCV (interferon era) (12)(13)(14).…”

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confidence: 99%

Severe Vitamin D Deficiency Increases Mortality Among Patients With Liver Cirrhosis Regardless of the Presence of HCC

Buonomo

Scotto

Zappulo

et al. 2018

In Vivo

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Background: The aim of this study was to investigate the association between vitamin D deficiency (<10 mg/ml) and mortality in patients with and without hepatocellular carcinoma (HCC) in a cohort of patients with liver cirrhosis. Materials and Methods: A prospective study was conducted among 345 patients with liver cirrhosis. Results: At enrolment, 46 (13.3%) patients had HCC. Severe vitamin D deficiency was associated with mortality (p<0.01). At the survival analysis, alpha-fetoprotein >10 ng/ml (p=0.003), vitamin D deficiency (p<0.001), a Model for End-Stage Liver Disease score ≥15 (p<0.001), Child-Pugh class B and C (versus A) (p<0.001) and the presence of active HCC (p<0.001) were strongly associated with death. At the multivariate Cox regression analysis, only Child-Pugh class B and C (versus A) and vitamin D deficiency were found to be significantly associated with death during the follow-up period (p<0.001 and p=0.006, respectively). Conclusion: Vitamin D deficiency is common in patients with HCC, it is associated with active HCC and it negatively affects the overall survival of patients with cirrhosis.

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Severe Vitamin D Deficiency Increases Mortality Among Patients With Liver Cirrhosis Regardless of the Presence of HCC

Buonomo

Scotto

Zappulo

et al. 2018

In Vivo

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“…Several studies from different countries were made to announce that DAAs do not reduce and may even increase the risk of HCC both in patients with a history of HCC and those who were not diagnosed with it before the treatment [ 5 - 10 ]. That led to more complex cohort research [ 11 - 13 ] which revealed that the risk of HCC is not increased, although it remains high in patients with a sustained virological response despite the eradication of the virus, which is the oncogenic factor. The patients who were most subject to the development of HCC were those with established liver cirrhosis before the direct-acting antiviral treatment [ 11 ].…”

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Hepatocellular carcinoma after direct-acting antivirals: an unresolved problem. Review of five cases

Bartosiewicz

Mikuła

2019

ceh

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Aim of the studyTo present the problem of hepatocellular carcinoma (HCC) occurring in patients treated with direct-acting antiviral (DAA) agents and to draw attention to the fact that HCC may develop even after successful therapy and in patients who were not previously diagnosed with it.Material and methodsThe inclusion criterion was confirmation of successful DAA treatment prior to HCC among hepatitis C virus (HCV)-infected patients with liver cirrhosis. The analysed group consisted of 5 patients.ResultsIn three patients the emergence of hepatocellular carcinoma was very rapid. They developed sudden decompensation of liver function with its symptoms – ascites, oedema, coagulation dysfunction. Furthermore, they had liver encephalopathy and renal failure. One of the patients had cancer cell thrombosis. Two patients’ status was stable, but they were disqualified from liver surgery due to large size of the focal lesions and their plurality.ConclusionsDAAs, despite their high effectiveness in HCV treatment, still bear the risk of developing HCC. Patients after the therapy should remain under medical control for the early detection and treatment of the presumptive cancer.

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Treatment with direct-acting antivirals improves the clinical outcome in patients with HCV-related decompensated cirrhosis: results from an Italian real-life cohort (Liver Network Activity—LINA cohort)

Gentile

Scotto

Coppola³

et al. 2018

Hepatol Int

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Direct acting antiviral agents and hepatocellular carcinoma development: don’t take it for granted

Cited by 4 publications

References 13 publications

Severe Vitamin D Deficiency Increases Mortality Among Patients With Liver Cirrhosis Regardless of the Presence of HCC

Severe Vitamin D Deficiency Increases Mortality Among Patients With Liver Cirrhosis Regardless of the Presence of HCC

Hepatocellular carcinoma after direct-acting antivirals: an unresolved problem. Review of five cases

Treatment with direct-acting antivirals improves the clinical outcome in patients with HCV-related decompensated cirrhosis: results from an Italian real-life cohort (Liver Network Activity—LINA cohort)

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