Hepatitis C and Hepatocellular Carcinoma

With the significant burden of hepatocellular carcinoma (HCC) attributable to hepatitis C (HCV), prevention of HCC should first and foremost include treatment of hepatitis C. At the very least, any patient who is at risk for liver disease progression to advanced fibrosis should have HCV treated. This is potentially one of the single most important interventions that can be employed long-term to decrease the incidence of HCV-related HCC. Furthermore, efforts should be made in proactively treating HCV in patients listed for liver transplant with HCC and those HCC patients with limited tumor burden treated with curative intent. Studies exploring more specifically which patients with HCC receiving liver-directed therapy should also have HCV treated need to be performed. The overall cost effectiveness of treating those with significant HCC tumor burden needs to be better understood. With new direct acting antivirals for the treatment of HCV, it is becoming increasingly difficult to find reasons to leave virtually any patient with hepatitis C untreated who is at risk for HCC or with HCC. Although there are limited data directly linking the treatment of HCV with the incidence of HCC, this is a tremendous opportunity to change the epidemiology of HCC by utilizing treatment for hepatitis C.