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Letter to the Editor| Volume 68, ISSUE 4, P844-845, April 2018

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Direct antiviral agents against hepatitis C virus: Beneficial or harmful?

Published:October 31, 2017DOI:https://doi.org/10.1016/j.jhep.2017.10.026
Direct antiviral agents against hepatitis C virus: Beneficial or harmful?
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      Development of direct antiviral agents (DAAs) for Hepatitis C virus (HCV) has enabled most patients to obtain sustained virologic response (SVR). Recently, some studies have described high rates of occurrence (de novo) and recurrence (in very short lapse of time after successful treatment) of hepatocellular carcinoma (HCC) after treatment with DAAs and this fact has produced global alarm.
      • Reig M.
      • Marino Z.
      • Perello C.
      • Inarrairaegui M.
      • Ribeiro A.
      • Lens S.
      • et al.
      Unexpected high rate of early tumor recurrence in patients with HCV-related HCC undergoing interferon-free therapy.
      J Hepatol. 2016; 65: 719-726
      Many letters have been written on the subject, even a recent meta-analysis.
      • Ioannou G.N.
      • Green P.K.
      • Berry K.
      HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma.
      J Hepatol. 2018; 68: 25-32
      Notes of caution regarding aspects like statistical analysis, selection bias, and lack of power have been most commonly reported.
      • Cardoso H.
      • Vale A.M.
      • Rodrigues S.
      • Goncalves R.
      • Albuquerque A.
      • Pereira P.
      • et al.
      High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis.
      J Hepatol. 2016; 65: 1070-1071
      , 
      • Yang J.D.
      • Aqel B.A.
      • Pungpapong S.
      • Gores G.J.
      • Roberts L.R.
      • Leise M.D.
      Direct acting antiviral therapy and tumor recurrence after liver transplantation for hepatitis C-associated hepatocellular carcinoma.
      J Hepatol. 2016; 65: 859-860
      , 
      • Torres H.A.
      • Vauthey J.N.
      • Economides M.P.
      • Mahale P.
      • Kaseb A.
      Hepatocellular carcinoma recurrence after treatment with direct-acting antivirals: first, do no harm by withdrawing treatment.
      J Hepatol. 2016; 65: 862-864
      , 
      • Camma C.
      • Cabibbo G.
      • Craxi A.
      Direct antiviral agents and risk for HCC early recurrence: much ado about nothing.
      J Hepatol. 2016; 65: 861-862

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      References

        • Reig M.
        • Marino Z.
        • Perello C.
        • Inarrairaegui M.
        • Ribeiro A.
        • Lens S.
        • et al.
        Unexpected high rate of early tumor recurrence in patients with HCV-related HCC undergoing interferon-free therapy.
        J Hepatol. 2016; 65: 719-726
        View in Article
        • Ioannou G.N.
        • Green P.K.
        • Berry K.
        HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma.
        J Hepatol. 2018; 68: 25-32
        View in Article
        • Cardoso H.
        • Vale A.M.
        • Rodrigues S.
        • Goncalves R.
        • Albuquerque A.
        • Pereira P.
        • et al.
        High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis.
        J Hepatol. 2016; 65: 1070-1071
        View in Article
        • Yang J.D.
        • Aqel B.A.
        • Pungpapong S.
        • Gores G.J.
        • Roberts L.R.
        • Leise M.D.
        Direct acting antiviral therapy and tumor recurrence after liver transplantation for hepatitis C-associated hepatocellular carcinoma.
        J Hepatol. 2016; 65: 859-860
        View in Article
        • Torres H.A.
        • Vauthey J.N.
        • Economides M.P.
        • Mahale P.
        • Kaseb A.
        Hepatocellular carcinoma recurrence after treatment with direct-acting antivirals: first, do no harm by withdrawing treatment.
        J Hepatol. 2016; 65: 862-864
        View in Article
        • Camma C.
        • Cabibbo G.
        • Craxi A.
        Direct antiviral agents and risk for HCC early recurrence: much ado about nothing.
        J Hepatol. 2016; 65: 861-862
        View in Article
        • Hsu Y.C.
        • Ho H.J.
        • Wu M.S.
        • Lin J.T.
        • Wu C.Y.
        Postoperative peg-interferon plus ribavirin is associated with reduced recurrence of hepatitis C virus-related hepatocellular carcinoma.
        Hepatology. 2013; 58: 150-157
        View in Article
        • Tsai P.C.
        • Huang C.F.
        • Yu M.L.
        Unexpected early tumor recurrence in patients with hepatitis C virus-related hepatocellular carcinoma undergoing interferon-free therapy: issue of the interval between HCC treatment and antiviral therapy.
        J Hepatol. 2017; 66: 464
        View in Article
        • Reig M.
        • Boix L.
        • Bruix J.
        The impact of direct antiviral agents on the development and recurrence of hepatocellular carcinoma.
        Liver Int. 2017; 37: 136-139
        View in Article

      Article info

      Publication history

      Published online: October 31, 2017

      Identification

      DOI: https://doi.org/10.1016/j.jhep.2017.10.026

      Copyright

      © 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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