Beyond the cure: Navigating hepatocellular risk and surveillance after hepatitis C eradication in the direct-acting antiviral era
2025-03-20
(Press-News.org)
Hepatitis C virus (HCV) infection remains a major global health burden, affecting millions worldwide and contributing significantly to hepatocellular carcinoma (HCC) development. The introduction of direct-acting antivirals (DAAs) has revolutionized HCV treatment, achieving high rates of sustained virologic response (SVR) and reducing HCV-associated morbidity and mortality. Despite these advancements, the risk of HCC persists in certain populations, particularly those with pre-treatment cirrhosis or advanced fibrosis (F3). This review examines the impact of DAAs on HCC risk, explores the underlying mechanisms of hepatocarcinogenesis post-HCV eradication, identifies key risk factors, and discusses optimal HCC surveillance strategies.
DAA Impact on HCC: Turning the Tide on Risk Reduction
DAA therapy has significantly reduced the risk of HCC in HCV-infected patients by eliminating viral replication and decreasing hepatic inflammation. Compared to interferon-based therapy, DAAs achieve superior SVR rates and mitigate fibrosis progression. However, early concerns arose regarding increased HCC recurrence rates in patients treated with DAAs. Subsequent large-scale cohort studies confirmed that DAAs are not associated with higher HCC risk than interferon-based therapy and that achieving SVR remains the most critical factor in reducing HCC incidence. Meta-analyses have further reinforced these findings, demonstrating comparable long-term outcomes between DAA and interferon-treated patients.
Decoding the Pathogenesis of HCC after HCV Eradication: Genetic and Epigenetic Alterations
While HCV eradication significantly reduces hepatic inflammation and fibrosis progression, oncogenic pathways activated during chronic infection may persist post-SVR. Genetic mutations, including alterations in the telomerase reverse transcriptase (TERT) gene and disruptions in pathways such as Wnt/β-catenin, p53, and PI3K/Akt/mTOR, contribute to hepatocarcinogenesis. Additionally, HCV-induced epigenetic modifications, including histone acetylation and DNA methylation, may sustain a pro-carcinogenic environment even after viral clearance. Studies indicate that liver transcriptomic profiles in post-SVR patients retain features associated with increased HCC risk, highlighting the need for ongoing surveillance in high-risk groups.
Risk Factors for HCC after HCV Eradication
Despite SVR, HCC risk remains elevated in patients with pre-treatment cirrhosis, bridging fibrosis (F3), or liver stiffness measurements above 10 kPa. Additional risk factors include metabolic disorders such as diabetes mellitus and hepatic steatosis, which exacerbate fibrosis and promote carcinogenesis. Alcohol consumption is an independent risk factor that synergizes with other comorbidities to heighten HCC risk. Moreover, elevated post-treatment alpha-fetoprotein (AFP) levels and advanced age are associated with increased HCC incidence. A personalized risk assessment approach is crucial to identifying patients who may benefit from continued surveillance despite achieving SVR.
HCC Surveillance after SVR
Professional guidelines offer varying recommendations for HCC surveillance post-SVR, particularly for patients with F3 fibrosis. While there is consensus on lifelong semi-annual surveillance for cirrhotic patients, guidelines differ regarding F3 patients. The European Association for the Study of the Liver (EASL) and the Asian Pacific Association for the Study of the Liver (APASL) recommend semi-annual surveillance for F3 patients, whereas the American Association for the Study of Liver Diseases (AASLD) does not. Given the relatively low annual HCC incidence in F3 patients, routine surveillance may not be cost-effective unless additional risk factors are present. A risk-stratified approach integrating non-invasive fibrosis assessments, AFP measurements, and imaging modalities such as ultrasound or MRI can help optimize HCC detection strategies in post-SVR patients.
Conclusions
DAAs have markedly transformed HCV management, significantly reducing but not eliminating HCC risk. While patients with cirrhosis warrant lifelong surveillance, the necessity of routine monitoring in F3 patients remains debated. A tailored, risk-based approach is essential to balance the benefits of early HCC detection with the cost-effectiveness of surveillance. Future research should focus on refining risk prediction models and optimizing individualized surveillance strategies to improve long-term outcomes for HCV-cured patients.
Full text
https://www.xiahepublishing.com/2310-8819/JCTH-2024-00499
The study was recently published in the Journal of Clinical and Translational Hepatology.
The Journal of Clinical and Translational Hepatology (JCTH) is owned by the Second Affiliated Hospital of Chongqing Medical University and published by XIA & HE Publishing Inc. JCTH publishes high quality, peer reviewed studies in the translational and clinical human health sciences of liver diseases. JCTH has established high standards for publication of original research, which are characterized by a study’s novelty, quality, and ethical conduct in the scientific process as well as in the communication of the research findings. Each issue includes articles by leading authorities on topics in hepatology that are germane to the most current challenges in the field. Special features include reports on the latest advances in drug development and technology that are relevant to liver diseases. Regular features of JCTH also include editorials, correspondences and invited commentaries on rapidly progressing areas in hepatology. All articles published by JCTH, both solicited and unsolicited, must pass our rigorous peer review process.
Follow us on X: @xiahepublishing
Follow us on LinkedIn: Xia & He Publishing Inc.
END
[Attachments] See images for this press release:
ELSE PRESS RELEASES FROM THIS DATE:
2025-03-20
The Lupus Research Alliance (LRA) is proud to announce the inaugural recipients of the new Targeted Research Program on Engineered Cell Therapies for Lupus (TRP-ECT) to support the development and mechanistic understanding of safe and accessible next-generation engineered cell therapies for people with lupus. Engineered cell therapies, such as CD19-targeted chimeric antigen receptor (CAR) T cells, involve reengineering a patient’s own T cells to recognize and attack cells that cause disease.
The LRA established this program to build upon the promise already shown for engineered cell therapies in treating and potentially curing lupus, including ...
2025-03-20
Washington, D.C.—Researchers have discovered that an enzyme can serve as an ideal target for developing new therapeutics against Lyme disease, and most likely other tick-borne diseases as well. The finding was reported in mBio, a journal of the American Society for Microbiology.
Lyme disease is the most commonly reported tick-borne illness in the United States and Europe. Its causative pathogen, Borrelia burgdorferi, has evolved unique metabolic pathways to cope with its enzootic life cycle, ...
2025-03-20
Two different teams of astronomers have detected oxygen in the most distant known galaxy, JADES-GS-z14-0. The discovery, reported in two separate studies, was made possible thanks to the Atacama Large Millimeter/submillimeter Array (ALMA), in which the European Southern Observatory (ESO) is a partner. This record-breaking detection is making astronomers rethink how quickly galaxies formed in the early Universe.
Discovered last year, JADES-GS-z14-0 is the most distant confirmed galaxy ever found: it is so far away, its light took 13.4 billion years to reach us, meaning we see it as it was when the Universe was less than 300 million years old, about 2% of its present age. ...
2025-03-20
Media Contact:
John Dudley
(814) 490-3290 (cell)
jjdudley@usf.edu
Images and a PDF of the journal article are available here
The study is the first to identify viruses associated with Karenia brevis, the single-celled organism that causes red tide
The findings are an initial step toward exploring viruses as biocontrol agents for red tide
TAMPA, Fla. (March 18, 2025) – A new study led by researchers at the University of South Florida shines light on the environmental drivers of red tide blooms.
Published in the American Society for Microbiology’s journal mSphere, ...
2025-03-20
Professor Im Joo Rhyu, director of the Korea University Graduate Program for Convergence & Translational Biomedicine and faculty member in the Department of Anatomy, recently led a study investigating the medical and artistic significance of the red, blood cell-like forms in Gustav Klimt’s The Kiss. Collaborating with Professors Hyunmi Park, Dae Hyun Kim, and Hwamin Lee from Korea University College of Medicine (KUCM) and Sungkyunkwan University Master's student Daeun Kwak, the research team delved into medical literature ...
2025-03-20
People diagnosed with colorectal cancer are significantly more likely to die of cardiovascular causes than the general population, especially in the first two years after their cancer diagnosis and in people younger than 50, according to a study being presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).
With colorectal cancer on the rise in the United States, the study is the first to track rates of cardiovascular mortality and assess how risk changes over time. While the reasons for the linkage are not yet known, researchers say ...
2025-03-20
Women of childbearing age who had both ovaries removed, in a procedure called bilateral oophorectomy, were more likely to develop heart failure later in life, according to a study being presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).
Bilateral oophorectomy is often recommended to treat and, in some cases, prevent certain health issues, including endometriosis, pelvic inflammatory disease, heavy bleeding and ovarian cancer. The new study sheds light on the potential and unique role that this procedure might play in heightening cardiovascular risk given that it abruptly stops ...
2025-03-20
The answer to your heart health may be on your wrist, a new study suggests. Researchers have developed a new way to assess cardiovascular health based on information routinely collected by smartwatches, according to a study being presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).
According to the findings, dividing the average daily heart rate by the number of steps taken per day provides a more reliable indicator of a person’s cardiovascular fitness compared with either heart rate or step count alone.
“The metric we developed looks at how the heart responds to exercise, rather than exercise itself,” said Zhanlin Chen, ...
2025-03-20
Mammograms, with the help of artificial intelligence (AI) models, may reveal much more than cancer, according to a study being presented at the American College of Cardiology’s Annual Scientific Session (ACC.25). The findings highlight how these important cancer screening tools can also be used to assess the amount of calcium buildup in the arteries within breast tissue—an indicator of cardiovascular health.
The U.S. Centers for Disease Control and Prevention recommends that middle-aged and older women get a mammogram—an X-ray of the breast—to screen for breast cancer every one or two ...
2025-03-20
DALLAS, March 20, 2025 — Stroke is the fourth leading cause of death in India and the fifth leading cause of disability.[1] To establish a coordinated system of care for stroke in the country, Apollo Hospital in Hyderabad, Telangana, and Aster Hospital in Calicut, Kerala, are the first in India to be certified as Comprehensive Stroke Centers by the American Stroke Association.
Launched in India last year, certifications from American Stroke Association, a division of the American Heart Association, devoted to a world ...
LAST 30 PRESS RELEASES:
[Press-News.org] Beyond the cure: Navigating hepatocellular risk and surveillance after hepatitis C eradication in the direct-acting antiviral era
