With advent of direct-acting antivirals (DAAs) against hepatitis C virus (HCV), sustained virological response ≥95% has been achieved in all infection categories, including coinfections with human immunodeficiency virus (HIV). However, in patients with HIV coinfected with hepatitis C/B, hepatocellular carcinoma (HCC) incidence increased by 11% per calendar year between 2001 and 2014. In a recent study published in journal AIDS, HCC risk after DAA treatment in patients coinfected with HIV–HCV was evaluated.
322 HIV-HCV-coinfected patients from 32 centers across Spain were evaluated. Frequency of de novo HCC decreased markedly from 15% in interferon period to 1.62% in DAA period. HCC recurrence rate in patients receiving interferon-based regimen vs DAA combination was similar (25% vs 21%).
Although these findings were reassuring, data did not suggest that risk for HCC is abolished after HCV eradication. Authors suggest crucial need for regular screening for HCC in coinfected patients with residual cirrhosis after achieving HCV cure. A minimum of 6 monthly screening consisting of an ultrasound examination by an expert radiologist with a computed tomography scan or magnetic resonance imaging, in case of doubt of the presence of intraparenchymal nodules should be performed.
An associated editorial called for more well-designed prospective cohort studies to end the controversy on occurrence or recurrence of HCC after DAA treatment. However, despite of this controversy, author comments, “There should be no reservations about the positive long-term impact of eradicating HCV in individuals with a high risk of developing end-stage liver disease.”