Context: The emergence of direct-acting ANTIVIRAL AGENTS (DAAs) with high sustained virological responses (SVR) is an epoch-making revolution. However, the value of ANTIVIRAL AGENTS in the field of hepatitis C-related hepatocellular carcinoma (HCC) is not clear. Further, the risk of tumor occurrence or recurrence following an ANTIVIRAL regimen is not yet reached a consensus. Evidence Acquisition: All scientific evidence was collected through a systematic review of studies discussing DAA regimen and hepatitis C-related HCC, in PubMed, EMBASE, andWeb of Science. The relevant articles were obtained and reviewed carefully before working on the paper. Results: The current review study aimed at discussing recent studies on hepatitis C-related HCC in the era of DAAs, including application of DAAs in the field of treatment of hepatitis C virus (HCV), efficacy of DAAs on HCV-associated HCC, and the effect of DAAs on occurrence and recurrence of HCC. Conclusions: It was shown that DAAs had a relatively poor therapeutic effect on HCV patients with HCC, based on the current studies. After analyzing the existing data, the conclusion cannot yet be reached that DAA treatment influences the risk of HCCin patients with HCV infection.

The recurrence of HCVinfection after liver transplantation was the main cause of mortality and loss of graft in transplanted patients until the use of direct-acting ANTIVIRALs (DAAs). We performed amonocentric retrospective study from November 2014 to September 2017 at “ Ospedali Riuniti” , Ancona, Italy, to evaluate the outcome and tolerability of DAAs after liver transplantation. In total, 55 patients with HCV recurrence after liver transplantation treated with DAAs were included. The most frequent genotype was genotype 1a (36%), followed by genotype 3a (27%). The majority of the patients presented a mild or moderate hepatic fibrosis (METAVIR score of F0-F1 in 20% and F2 in 27%). The patients received sofosbuvir + daclatasvir, sofosbuvir + ribavirin, sofosbuvir + simeprevir, sofosbuvir + ledipasvir, and sofosbuvir + velpatasvir in 54%, 18%, 13%, 13%, and 2% of the cases, respectively, for 12 or 24 weeks. The SVR 12 rate was 89% overall, without a statistically significant relationship with genotypes, fibrosis stage, and therapy. Moreover, 52% of the patients modified the dosage of tacrolimus in the first three months of therapy with DAAs, without statistical significance compared to the group that not changed tacrolimus dosage. The most frequent adverse events were anemia associated with ribavirin. IFN-free treatment with DAAs is highly effective for HCV relapse after liver transplantation and it showed high tolerability in our patients.

Introduction: A new pathological form of HCV named as occult HCV infection (OCI) has been recently characterized by the presence of HCV RNA in liver biopsy and/or peripheral blood mononuclear cell specimens (PBMCs) and the absence of detectable circulating HCV RNA in plasma samples. In this study, we investigated the presence of HCV RNA in PBMCs and plasma samples of 100 hemophilia patients with negative serum HCV RNA. Methods: One hundred hemophilia participants receiving IFN-free direct-acting ANTIVIRALs (DAAs) regimens as a treatment of HCV infection participated in this study. PBMCs were separated with Ficoll before RNA extraction. The HCV genotypes of the positive specimens were also analyzed by RT-PCR assay. Finally, data analysis was performed by SPSS software. Results: Our data revealed that out of 100 hemophilia patients, three (3%, 95% CI: 0. 006-0. 085) were positive for OCI, showing a significant association between OCI and genotype3/drug regimens (p = 0. 0203). There was no significant increase at ALT and AST levels in patients with OCI. Moreover, a genotype difference was observed between plasma and PBMCs samples of 1% (1/100) of patients. Conclusion: Generally, HCV genotyping in PBMCs along with plasma subtyping before beginning the therapy is vital due to the possibility of OCI detection.