Hepatocellular carcinoma following direct anti-viral for hepatitis C treatment: a report of an Egyptian case series

Abstract

How to cite this article: Rewisha EA, Elsabaawy MM, Elshaarawy O, Abdallah A, Elsabaawy DM, Alhaddad OM. Hepatocellular carcinoma following direct anti-viral for hepatitis C treatment: a report of an Egyptian case series. Hepatoma Res 2017;3:178-81.Egypt had been vexed by the highest load of chronic hepatitis C in the world. It represents a vast market of the new direct-acting anti-viral drugs (DAAs); effectively treating chronic hepatitis C virus (HCV) infection. Eradication of HCV in Egypt has been challenged by the observed increased diagnosis of hepatocellular carcinoma (HCC) in relation to DAAs therapy. This is the first Egyptian report annotating to a series of sixteen chronic HCV infected cases without a diagnosis of HCC before DAAs therapy and unexpected development of HCC during or after completion of DAAs therapy. Key words:Chronic hepatitis C, direct-acting anti-viral drugs, hepatocellular carcinoma, Egypt ABSTRACTArticle history:

New incidence or recurrence hepatocellular carcinoma (HCC) in genotype 4 hepatitis C virus treated with sofosbuvir/daclatasvir with or without ribavirin

“…Upon studying the follow-up parameters of the patients who developed HCC in the current study it was found that there was an increase in Child scores, ALT, AST, bilirubin, WBCs, INR, and AFP values while there was a decrease in albumin, hemoglobin, and platelets levels, those results came in agreement with those detected by Rewisha et al 13 Concerning the virological response, patients in this study achieved 100% SVR which is greater than the percentages of both Mann et al (84.9%) and Pariente et al (91.1%); this difference in results may be attributed to the genotype difference of the patients and their response to the Sof/Dac regimen. 15,16 Concerning the biochemical parameters of the patients in the two groups, the comparison resulted in significantly lower values in SOF/DAC group than SOF/DAC/RIB group in child score, bilirubin, INR, and AFP with P values <0.05.…”

“…Researchers found no raise in the development of HCC and an approximately low risk of recurrence of HCC. 13 Concerning HCC incidence in the current study, six patients out of 71 from the SOF/DAC/RIB group had developed HCC with an incidence rate of 8.5% in a mean time 18 weeks from starting the DAAs treatment. These results came in agreement with those reported by Conti et al who reported HCC incidence of 7.6% in DAA-treated patients.…”

Safety and efficacy of combined sofosbuvir/daclatasvir treatment of children and adolescents with chronic hepatitis C Genotype 4

“…Although studies using combined SOF/DCV in adult GT‐4 CHC patients are well documented, to our knowledge, this is the first study of SOF/DCV including children under 12 years of age, and the first study of any DAA regimen in children under 12 years of age with GT‐4 or mixed GT‐4 and GT‐1.…”

“…To monitor for the possible development of HCC triggered by DAA treatment, ultrasonography and AFP were performed before treatment, at the end of treatment, and at weeks 12, 24 and 48 after treatment. We were keen to check for HCC because some previous studies have linked SOF treatment with HCC development …”

“…We were keen to check for HCC because some previous studies have linked SOF treatment with HCC development. 35 RT-PCR for HCV RNA was first done before treatment, at week 4 of treatment, week 12 (end of treatment), and at week 48 post-treatment for the 14 patients that reached 48 weeks posttreatment at the time of writing this manuscript. As the primary outcome of our study was to assess efficacy of combined SOF/DCV in attaining a sustained viral clearance at both weeks 12 (SVR12) and 24 (SVR24) post-treatment (defined as serum HCV RNA below the quantification limit by real-time quantitative PCR (qPCR), <12 IU/ mL)), HCV RNA was tested by qPCR at week 12 as well as week 24 post-treatment.…”