Risk of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Who Achieved Sustained Virological Response

The recent development of interferon-free direct-acting antivirals (DAAs) has had a significant impact on the already great advances made in the treatment of hepatitis C. Combination therapy with pegylated interferon, ribavirin and simeprevir has achieved a sustained virological response (SVR) rate of approximately 70% in patients with hepatitis C caused by the genotype Ib virus. Combination therapy using daclatasvir and asunaprevir, which was approved in Japan in September 2014, has increased the SVR rate to approximately 95%. A clinical trial testing sofosbuvir-ledipasvir combination therapy (approved in September 2015 in Japan and October and November 2014 in the USA and EU, respectively) showed an SVR rate of nearly 100% in patients with genotype 1b hepatitis C virus. Combination therapy with ombitasvir and paritaprevir, which has a powerful therapeutic effect (SVR rate ≥95%), also became available in Japan from November 2015. Because interferon-based therapy is not possible in patients aged >70 years, in patients with cirrhosis, or in patients with a low platelet count, the above DAAs (which have extremely low rates of adverse effects) are extensively indicated. DAAs can be administered to almost all hepatitis C patients, including the elderly and those with compensated liver cirrhosis, and rapidly eradicate hepatitis C viruses; high SVR rates are achieved even in elderly cirrhotic patients with a high risk of liver cancer. Consequently, a new clinical problem has emerged, namely, the development of liver cancer after SVR [1,2,3,4,5,6,7,8,9,10,11,12]. Thus, two new unmet needs have arisen in the clinical setting: (1) finding the best possible way to assess the risk of liver cancer development after SVR is achieved and (2) establishing a liver cancer screening program for these patients [13,14].