期刊
BMC MEDICINE
卷 15, 期 -, 页码 -出版社
BMC
DOI: 10.1186/s12916-017-0815-7
关键词
Hepatitis C virus; Hepatocellular carcinoma; Interferon; Direct-acting antivirals; Sustained virologic response
资金
- European Union [ERC-2014AdG-671231HEPCIR, H2020-667273-HEPCAR]
- European Union (ANRS)
- European Union (French Cancer Agency) [ARC IHU201301187]
- IdEx program of the University of Strasbourg
- Foundation University of Strasbourg
- U.S. NIH/NIDDK [R01 DK099558]
- Irma T. Hirschl Trust
- U.S. Department of Defense [W81XWH-16-1-0363 YH]
- French National Research Agency
Hepatitis C virus infection is a major cause of hepatocellular carcinoma worldwide. Interferon has been the major antiviral treatment, yielding viral clearance in approximately half of patients. New direct-acting antivirals substantially improved the cure rate to above 90%. However, access to therapies remains limited due to the high costs and under-diagnosis of infection in specific subpopulations, e.g., baby boomers, inmates, and injection drug users, and therefore, hepatocellular carcinoma incidence is predicted to increase in the next decades even in high-resource countries. Moreover, cancer risk persists even after 10 years of viral cure, and thus a clinical strategy for its monitoring is urgently needed. Several risk-predictive host factors, e.g., advanced liver fibrosis, older age, accompanying metabolic diseases such as diabetes, persisting hepatic inflammation, and elevated alpha-fetoprotein, as well as viral factors, e.g., core protein variants and genotype 3, have been reported. Indeed, a molecular signature in the liver has been associated with cancer risk even after viral cure. Direct-acting antivirals may affect cancer development and recurrence, which needs to be determined in further investigation.
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