HCV eradication does not eliminate hepatocellular carcinoma risk

Hepatitis C virus (HCV) infection affects millions globally and significantly increases the risk of developing liver cancer, known as hepatocellular carcinoma (HCC). Advances in treatment with direct-acting antivirals (DAAs) have improved recovery rates, but the risk of HCC remains, particularly for patients with existing liver damage. Studies show that DAAs lower HCC risk by stopping viral replication and reducing liver inflammation. Early fears suggested they might increase HCC recurrence, but large studies have found that DAAs do not raise this risk compared to older treatments. Achieving a sustained viral response (SVR) is the most important factor in lowering HCC rates. However, even after HCV is cleared, some harmful changes in the liver may persist. Genetic mutations and epigenetic changes can create an environment that continues to support cancer development. Research indicates that some liver changes linked to higher HCC risk remain even after successful treatment, emphasizing the need for ongoing monitoring. Certain risk factors for HCC still exist after HCV treatment. Patients with significant liver damage before treatment, such as cirrhosis or advanced fibrosis, are at higher risk. Lifestyle factors like obesity, diabetes, and alcohol use can also increase this risk. Additionally, older age and higher levels of a specific protein called alpha-fetoprotein (AFP) are linked to greater chances of developing HCC. Guidelines for monitoring HCC in patients who have achieved SVR vary among health organizations. Most agree that those with cirrhosis need regular check-ups for life. For patients with advanced fibrosis, recommendations differ. Some organizations suggest bi-annual monitoring, while others find it may not be necessary without additional risk factors. In conclusion, while DAAs have significantly improved HCV treatment and reduced HCC risk, ongoing monitoring remains vital for certain patients. A personalized approach using risk assessments can help determine the best surveillance strategy to catch any potential cancer early. Future research will aim to enhance these monitoring strategies to improve outcomes for those cured of HCV.