Direct‐Acting Antiviral Therapy and Hepatocellular Carcinoma

Rich, Nicole E.; Singal, Amit G.

doi:10.1002/cld.1082

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…[ 99 ] Furthermore, the trajectory of cirrhosis is no longer considered to be unidirectional, particularly with lifestyle changes (e.g., alcohol abstinence) and effective treatments for the underlying insult (e.g., antiviral therapies for hepatitis B or C infection) that can improve fibrosis and result in “recompensation.” [ 100 ] Antiviral treatment for HBV and HCV in patients with HCC may also preserve liver function and reduce the risk of and/or improve decompensation and therefore make subsequent HCC treatments feasible. [ 101‐103 ] In the future, the availability of antifibrotic drugs may further affect competing risk of liver‐related mortality and shift the risk‐benefit ratio of HCC surveillance in patients with Child‐Pugh B or C cirrhosis.…”

Section: Drivers Of Overdiagnosis and Guideline Efforts To Mitigate O...mentioning

confidence: 99%

“…[100] Antiviral treatment for HBV and HCV in patients with HCC may also preserve liver function and reduce the risk of and/ or improve decompensation and therefore make subsequent HCC treatments feasible. [101][102][103] In the future, the availability of antifibrotic drugs may further affect competing risk of liver-related mortality and shift the risk-benefit ratio of HCC surveillance in patients with Child-Pugh B or C cirrhosis.…”

Section: Competing Risks Of Mortalitymentioning

confidence: 99%

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Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines?

Rich

2022

Hepatology

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Overdiagnosis refers to detection of disease that would not otherwise become clinically apparent during a patient's lifetime. Overdiagnosis is common and has been reported for several cancer types, although there are few studies describing its prevalence in HCC surveillance programs. Overdiagnosis can have serious negative consequences including overtreatment and associated complications, financial toxicity, and psychological harms related to being labeled with a cancer diagnosis. Overdiagnosis can occur for several different reasons including inaccurate diagnostic criteria, detection of premalignant or very early malignant lesions, detection of indolent tumors, and competing risks of mortality. The risk of overdiagnosis is partly mitigated, albeit not eliminated, by several guideline recommendations, including definitions for the at-risk population in whom surveillance should be performed, surveillance modalities, surveillance interval, recall procedures, and HCC diagnostic criteria. Continued research is needed to further characterize the burden and trends of overdiagnosis as well as identify strategies to reduce overdiagnosis in the future.

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Section: Drivers Of Overdiagnosis and Guideline Efforts To Mitigate O...mentioning

confidence: 99%

Section: Competing Risks Of Mortalitymentioning

confidence: 99%

Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines?

Rich

2022

Hepatology

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“…DAAs appear safe for patients with a history of treated HCC and are not associated with an increased risk for cancer recurrence except for cases with vascular invasion, where aggressive HCC recurrence was reported[ 67 ]. For HCC patient candidates for a liver transplant, decisions regarding the timing of DAA treatment depend on organ availability and region wait times and should be individualized[ 68 ].…”

Section: Impact Of Direct-acting Antiviral Regimens On Hcv Infectionmentioning

confidence: 99%

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

Salama¹,

Raslan²,

Abdel‐Latif³

et al. 2022

WJH

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Hepatitis C virus (HCV) is a common cause of liver disease and is associated with various extrahepatic manifestations (EHMs). This mini-review outlines the currently available treatments for HCV infection and their prognostic effect on hepatic manifestations and EHMs. Direct-acting antiviral (DAA) regimens are considered pan-genotypic as they achieve a sustained virological response (SVR) > 85% after 12 wk through all the major HCV genotypes, with high percentages of SVR even in advanced fibrosis and cirrhosis. The risk factors for DAA failure include old males, cirrhosis, and the presence of resistance-associated substitutions (RAS) in the region targeted by the received DAAs. The effectiveness of DAA regimens is reduced in HCV genotype 3 with baseline RAS like A30K, Y93H, and P53del. Moreover, the European Association for the Study of the Liver recommended the identification of baseline RAS for HCV genotype 1a. The higher rate of hepatocellular carcinoma (HCC) after DAA therapy may be related to the fact that DAA regimens are offered to patients with advanced liver fibrosis and cirrhosis, where interferon was contraindicated to those patients. The change in the growth of pre-existing subclinical, undetectable HCC upon DAA treatment might be also a cause. Furthermore, after DAA therapy, the T cell-dependent immune response is much weaker upon HCV clearance, and the down-regulation of TNF-α or the elevated neutrophil to lymphocyte ratio might increase the risk of HCC. DAAs can result in reactivation of hepatitis B virus (HBV) in HCV co-infected patients. DAAs are effective in treating HCV-associated mixed cryoglobulinemia, with clinical and immunological responses, and have rapid and high effectiveness in thrombocytopenia. DAAs improve insulin resistance in 90% of patients, increase glomerular filtration rate, and decrease proteinuria, hematuria and articular manifestations. HCV clearance by DAAs allows a significant improvement in atherosclerosis and metabolic and immunological conditions, with a reduction of major cardiovascular events. They also improve physical function, fatigue, cognitive impairment, and quality of life. Early therapeutic approach with DAAs is recommended as it cure many of the EHMs that are still in a reversible stage and can prevent others that can develop due to delayed treatment.

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“…It is important that patients are closely monitored during antiviral treatment so that any side effects can be identified and treated. Overall, however, oral antiviral treatment is considered safe and effective in treating hepatitis and has significant benefits for overall health [3].…”

Section: Introductionmentioning

confidence: 99%

The Influence of Metabolic Factors in Patients with Chronic Viral Hepatitis C Who Received Oral Antiviral Treatment

Gavril

Mitu

et al. 2023

Metabolites

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Hepatic diseases pose a significant public health concern. Regardless of the severity of hepatic fibrosis, treatment is recommended for all chronic hepatitis C virus (HCV) subjects. However, fibrosis and steatosis assessment remains crucial for evaluating the prognosis, progression, and hepatic disease monitoring, particularly following the treatment with direct-acting antivirals (DAAs). The aim of our study was to evaluate the impact of metabolic factors and the extent of hepatic fibrosis and fat accumulation in chronic HCV infection subjects. Additionally, another objective was to investigate modifications regarding fibrosis and steatosis three months after a successful sustained viral response (SVR). A total of 100 patients with compensated cirrhosis and chronic hepatitis C (CHC) were included in our study. These patients received treatment with DAA and underwent Fibromax assessment before and three months post SVR. After DAA treatment, a significant decrease was observed in the degree of hepatic fibrosis and hepatic steatosis. This regression was evident three months following the achievement of SVR. Chronic viral hepatitis C may trigger risk factors for metabolic syndromes, such as obesity and type 2 diabetes mellitus. Conclusions: It is crucial to monitor metabolic factors and take timely measures to prevent or treat metabolic syndrome in patients with chronic viral hepatitis C.

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Direct‐Acting Antiviral Therapy and Hepatocellular Carcinoma

Abstract: Answer questions and earn https://www.wileyhealthlearning.com/7411729/Activity.aspx

Cited by 4 publications

References 14 publications

Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines?

Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines?

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

The Influence of Metabolic Factors in Patients with Chronic Viral Hepatitis C Who Received Oral Antiviral Treatment

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