The impact of the revolution in hepatitis C treatment on hepatocellular carcinoma

Direct-acting antiviral agents have revolutionized the treatment of chronic hepatitis C virus (HCV) infection. In the near future, these novel therapies will have a profound impact on HCV prevalence and HCV-induced carcinogenesis. In this review, we discuss treatment options of HCV patients with both compensated and decompensated cirrhosis as well as HCV patients in pre- and post-transplantation settings with a focus on the currently available data on HCC development in these patient populations.Hepatitis C infection represents a global health problem affecting similar to 200 million chronically infected patients worldwide. Owing to the development of a fibrogenic and inflammatory micromilieu in the liver, hepatitis C virus (HCV)-infected patients are at a high risk of developing fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The advent of direct-acting antiviral agents (DAAs), however, has spurred a revolution in the treatment of HCV patients with sustained viral response (SVR) rates exceeding 90% in real-life settings. Recent clinical trials suggest that these novel treatments will not only alter the epidemiology of HCV infection but also the incidence of HCV-induced complications including hepatic decompensation, liver transplantation and hepatocarcinogenesis. Here, we summarize data from clinical trials carried out in HCV patients with compensated and decompensated cirrhosis and analyze the impact of viral clearance on HCC development and treatment. Finally, we review and discuss current and future treatment options of HCV patients with HCC in pre- and post-transplantation settings.