Durability of virologic response after antiviral treatment in chronic hepatitis c virus infection andrisk of de novo hepatocellular carcinoma

AIM: To investigate the virologic response in patients with chronic hepatitis C infection and to obtain virological complete response after treatment with direct acting antiviral (DAA) and to investigate the rate of de novo hepatocellular cancer (HCC) development especially in cirrhotic patients. In addition, to reveal the risk factors of HCC. METHOD: This prospective study consisted of 110 chronic Hepatitis C virus infection patients, 63 of whom were male and 47 were female. The patients were also divided into two groups as cirrhotic (n = 48) and non-cirrhotic (n = 62). Patients were followed up for 4-45 months (median 28) after treatment with direct-acting antiviral. After the patients had a persistent viral response, hepatitis C virus was monitored for recurrence, hepatocellular cancer progression, or risk of developing de novo hepatocellular cancer. Dynamic MRI was performed to the patients once a year. in this study; 110 patients treated with Direct effect antiviral between June 2015 and May 2019 and followed for at least 1 year after treatment were included. RESULTS: Sustained viral response rate in patients treated with direct-acting antiviral was 107/110 (97.3%). Permanent viral response rate in noncirrhotic patients was 62/62 (100%), and persistent viral response rate in cirrhotic patients was 45/48 (93.75%). All patients were followed for 3-42 months (median 26). While progression occurred in one patient who previously had hepatocellular cancer, 3 of 44 cirrhotic patients who did not have hepatocellular cancer previously developed de novo hepatocellular cancer (3/44, 6.8%; 2.91 / year). MELD (p <0.005) and Child Pugh score (p <0.05) were determined as risk factors for HSK development in patients. CONCLUSIONS: It is safe to treat chronic HCV virus infection patients with DAA and its side effect profile is relatively low compared to conventional treatment. Treatment with DAA is successful and the rate of obtaining SVR is very high. There is no increased risk of HCC development in patients treated with DAA. Even if SVR develops after treatment with DAA in chronic HCV virus infection patients with liver cirrhosis, these patients should be followed up periodically, because of the risk of recurrence of HCC and de novo HCC. Patients with chronic HCV virus infection without cirrhosis may be excluded from follow-up after 1 year. The risk of developing HCC in these patients is the same as in the normal healthy population. KEYWORDS: Hepatitis C virus, Treatment, Direct acting antiviral drugs, Hepatocellular canser.