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Hepatitis C virus treatment by direct-acting antivirals in successfully treated hepatocellular carcinoma and possible mutual impact

Hassany, Mohameda; Elsharkawy, Aishac; Maged, Amra; Mehrez, Maia; Asem, Nohad; Gomaa, Ahmedg; Mostafa, Zeinabb; Abbas, Bahaaf; Soliman, Mohamade; Esmat, Gamalc

European Journal of Gastroenterology & Hepatology: August 2018 - Volume 30 - Issue 8 - p 876–881
doi: 10.1097/MEG.0000000000001152
Original Articles: Hepatology

Background and aims Treatment of hepatitis C virus (HCV) after successfully treated hepatocellular carcinoma (HCC) becomes possible with the introduction of direct-acting antivirals because of their favorable efficacy, safety, and short period of treatment. Few data are available on the results of treatment using different direct-acting antiviral regimens in successfully treated HCC and a lot of debate about its role in tumor recurrence.

Methods Sixty-two HCV-related HCC patients were enrolled in the study after successfully treated HCC; the studied population included either Child–Pugh ‘A’ or ‘B7’. The patients were subcategorized to receive one of the following regimens: group 1: sofosbuvir (SOF)+ribavirin (RBV) for 24 weeks, group 2: SOF+simeprevir for 12 weeks, group 3: SOF+daclatasvir for 24 weeks, and group 4: SOF+daclatasvir+RBV for 12 weeks. The overall median follow-up period is 12 months after treatment initiation.

Results All treatment regimens were tolerable for all patients, with no reported major adverse events during treatment. The overall sustained virologic response rate was 64.5%, with the highest result in group 4 and the lowest result in group 1; 87.5 and 26.7%, respectively. HCC recurrence was observed in 42% of patients; 80.7% of these patients developed recurrence within 6 months of treatment initiation.

Conclusion Treatment of HCV in successfully treated HCC is feasible, with the best results achieved using multiple direct-acting antivirals and RBV; a high rate of HCC recurrence was observed, especially within the first 6 months of treatment initiation (ClinicalTrials.gov no: NCT02771405).

aTropical Medicine Department

bRadiology Department, National Hepatology and Tropical Medicine Research Institute (NHTMRI)

cEndemic Medicine and Hepatogastroentrology Department

dCommunity Medicine Department

eHepatology and Gastroenterology, Liver Unit, Cairo University

fMilitary Medical Academy, Cairo

gTropical Medicine Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt

Correspondence to Mohamed Hassany, MD, Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute (NHTMRI), 10 Kasr Al Aini Street, Cairo 11441, Egypt Tel: +20 223 642 494; fax: +20 223 683 723; e-mail: mohamadhassany@yahoo.com

Received February 2, 2018

Accepted April 1, 2018

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