Does HCV antiviral therapy decrease the risk of hepatocellular carcinoma?
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- Pleguezuelo, M., Marelli, L., Maimone, S. et al. Curr hepatitis rep (2008) 7: 72. doi:10.1007/s11901-008-0011-5
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Whether antiviral therapy for hepatitis C virus (HCV) infection can prevent hepatocellular carcinoma (HCC) independent of a sustained virologic response (SVR) has been debated since a randomized trial from Japan in 1995. Incidence of HCC in patients with chronic hepatitis C with SVR is reduced through cirrhosis prevention, but HCC is also prevented in cirrhosis by reduction of necroinflammatory activity and possibly cell turnover. However, HCV patients with cirrhosis who achieve an SVR still have a risk, although a lower one, of HCC, so surveillance must continue. The potential antiproliferative effect of interferon (IFN) with respect to HCC has been discounted by a prospective randomized clinical trial in nonresponders to IFN (Hepatitis C Antiviral Long-term Treatment Against Cirrhosis [HALT-C]), in which IFN did not modify any outcomes. Thus, the best strategy to reduce HCC is to treat HCV-infected patients before they develop cirrhosis and to increase the SVR rate.