Hepatocellular carcinoma after direct-acting antivirals: an unresolved problem. Review of five cases

To present the problem of hepatocellular carcinoma (HCC) occurring in patients treated with direct-acting antiviral (DAA) agents and to draw attention to the fact that HCC may develop even after successful therapy and in patients who were not previously diagnosed with it.

The inclusion criterion was confirmation of successful DAA treatment prior to HCC among hepatitis C virus (HCV)-infected patients with liver cirrhosis. The analysed group consisted of 5 patients.

In three patients the emergence of hepatocellular carcinoma was very rapid. They developed sudden decompensation of liver function with its symptoms - ascites, oedema, coagulation dysfunction. Furthermore, they had liver encephalopathy and renal failure. One of the patients had cancer cell thrombosis. Two patients' status was stable, but they were disqualified from liver surgery due to large size of the focal lesions and their plurality.

DAAs, despite their high effectiveness in HCV treatment, still bear the risk of developing HCC. Patients after the therapy should remain under medical control for the early detection and treatment of the presumptive cancer.