Challenges in treatment of hepatitis C among patients with hepatocellular carcinoma

Patients with hepatitis C virus (HCV) and hepatocellular carcinoma (HCC) present the unique challenge of when to treat their hepatitis C. In a group of 21 patients with HCV/HCC, we investigated the response to direct-acting antiviral (DAA) drugs before receiving a deceased donor liver transplant (LT). Subjects whose HCC was diagnosed on imaging either before or during HCV treatment were included. Seven of the 21 patients (33.3%) relapsed following treatment with various DAA regimens (Table 1A and Supporting Table S1). Of these 7 patients, 4 were infected with HCV genotype 1A, 1 genotype 2, and 2 with genotype 3. In the relapsers, the DAA regimens used were: 2 with ledipasvir/sofosbuvir, 1 with simeprevir and sofosbuvir, and 4 with sofosbuvir and ribavirin (Table 1A). Subsequently, all of the 7 relapsers were transplanted and their explant pathology was carefully reviewed. Six of the 7 patients had received locoregional therapy pre-LT and 1 had no evidence of viable tumor on the explant. One of the 7 had microvascular invasion on explant (Table 2A and Supporting Table S2). LTs were performed between 2 and 12 months after the end of treatment withDAAs (Fig. 1).