New incidence or recurrence hepatocellular carcinoma (HCC) in genotype 4 hepatitis C virus treated with sofosbuvir/daclatasvir with or without ribavirin

Background: Several studies have resulted in controversial data about the
recurrence or new incidence of hepatocellular carcinoma (HCC) in patients
with hepatitis C who were treated with direct-acting antivirals (DAAs).
  Aim: This observational study aimed to assess the occurrence
rate of HCC in patients who developed a sustained virological response
(SVR).. Methods: A six-month prospective study was done at the
National Hepatology and Tropical Medicine Research Institute [NHTMRI] in
Cairo, Egypt on 150 chronic hepatitis C (CHC) patients treated with
sofosbuvir and daclatasvir with or without ribavirin. Patients were
assigned into two groups according to their laboratory values to either
receive sofosbuvir/daclatasvir and ribavirin (S/D/R) or receive only
sofosbuvir/daclatasvir (S/D). The main outcome measure was the occurrence
of HCC. Results: SVR-12 was 100%. 8.5% of patients developed HCC in the
S/D/R group, while 0% in the S/D group. Conclusion:  New
incidence or recurrence of HCC may occur in CHC genotype 4 cirrhotic
patients receiving sofosbuvir/daclatasvir and ribavirin (difficult to
treat) although achieving SVR. The cause of HCC development in this study
is cirrhosis, not the administered DAAs.