Hepatocellular Carcinoma in the Era of Direct Antiviral Agents Against Hepatitis C Virus

The hepatitis C virus (HCV) is a major cause of liver-related morbidity and mortality, and a major risk factor of hepatocellular carcinoma (HCC) around the world. Early detection, continued prevention of transmission, and antiviral treatment of chronically infected persons are the pillars to decrease incidence and mortality of HCV. The widespread access to safe and effective direct acting anti-viral agents (DAA) has allowed the elimination of the infection possible in almost all treated patients, thus leading to a significant reduction of liver-related and overall mortality due to HCV in the cured population. Treatment of HCV does not completely eradicate HCC risk in populations with advanced liver disease and those with cofactors known to promote liver carcinogenesis such as diabetes, obesity, and excessive alcohol consumption. Molecular-based biomarkers are expected to overcome the limits of liver disease severity, thus improving the identification of screening candidates. The implementation of risk-stratified surveillance programs coupled with the identification of biomarkers to predict HCC in HCV cured patents is deemed necessary for implementing the cost-effective management of these patients.