What Comes First: Treatment of Viral Hepatitis or Liver Cancer?

  • Jordan J. FeldEmail author
  • Lisette A. P. Krassenburg


Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are the most important underlying causes for the development of hepatocellular carcinoma (HCC) worldwide. Determining the optimal approach for management of the viral infection and the HCC depends on the virus and the stage of the cancer. In patients with HCV-associated HCC, there are multiple reasons to first treat the HCC. Firstly, in case of a curable HCC, the urgency for HCC treatment is important to avoid progression during HCV treatment. Secondly, the presence of HCC itself appears to reduce the rates of sustained virological response (SVR) achieved with direct-acting antivirals (DAAs). And finally, the evidence does not support the concept of an increase in HCC recurrence due to DAAs, so a patient can safely be treated after HCC cure. For patients with very advanced HCC, the benefits of HCV therapy are questionable. In contrast, those who develop HCC in the setting of chronic HBV infection, treatment with nucleoside analogues (NAs) is recommended prior to treating HCC, to prevent further liver injury and reduce the risk for HCC recurrence. Ultimately, earlier diagnosis and treatment of HBV and HCV will hopefully reduce the incidence of HCC worldwide.


Hepatitis C virus (HCV) Sustained virological response (SVR) Hepatocellular carcinoma (HCC) Direct-acting antivirals (DAAs) Hepatitis B virus (HBV) 


Compliance with ethical standards

Conflict of interest

Dr. Jordan J. Feld reports receiving research funds from Abbvie, Gilead Sciences and Janssen as well as consulting fees from Abbvie, Gilead Sciences, Enanta, Contravir and Roche. Lisette A. P. Krassenburg reports no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Toronto Centre for Liver Disease, Toronto General Hospital, Sandra Rotman Centre for Global HealthUniversity of TorontoTorontoCanada
  2. 2.Department of Gastroenterology and HepatologyErasmus University Medical CenterRotterdamThe Netherlands

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