The impact of direct antiviral agents on the development and recurrence of hepatocellular carcinoma.

Direct antiviral agents mark a major progress for the treatment of chronic hepatitis C virus infection. The rate of cure is higher than 90% in most populations and the safety profile is good. However, like any treatment, there are potential unexpected adverse events. Several reports have indicated that antiviral therapy may be associated with the reactivation of hepatitis B virus or the emergence of herpes virus in a time-related manner. Recently, several studies have described a potential unexpected incidence of hepatocellular carcinoma in treated patients, both in those without a prior history of cancer and those who have been successfully treated and were disease-free for different periods of time. Furthermore, the emergence of cancer is also characterized by a more aggressive and faster progression to advanced stages, making treatment impossible. Thus, a careful risk-benefit analysis must be made when considering antiviral treatment with the new agents in patients with hepatitis C virus.