title: Hepatocellular carcinoma in long-term sustained virological responders following antiviral combination therapy for chronic hepatitis C.
abstract: Antiviral treatment results in a sustained virologic response (SVR) in 50-75% of patients with chronic hepatitis C. Long-term follow up studies have observed ongoing SVR in the overwhelming majority of them. Thus chronic hepatitis C is considered 'cured' if an SVR is achieved. Consequently, it is expected that in sustained virologic responders long-term complications of hepatatic C virus (HCV) related chronic liver disease including hepatocellular carcinoma are eliminated or have a decreased incidence. We report on five patients (three from Austria, two from USA) who developed hepatocellular carcinoma during follow up (3-6 years) after achieving SVR. During follow up and at diagnosis all were HCV-RNA neg. None of the patients had other liver diseases. One patient presented with bilateral adrenal metastasis, the remaining four with large hepatic tumours. Three patients were noncirrhotic at the start of treatment at the time of tumour diagnosis. Successful antiviral treatment in HCV patients does not prevent development of hepatocellular carcinoma even in non-cirrhotic livers. Long-term follow up of patients with SVR is mandatory and should include surveillance for hepatocellular carcinoma.
authors.affiliation: Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
authors.forename: T-M
authors.initials: TM
authors.lastname: Scherzer
authors.forename: K R
authors.initials: KR
authors.lastname: Reddy
authors.forename: F
authors.initials: F
authors.lastname: Wrba
authors.forename: H
authors.initials: H
authors.lastname: Hofer
authors.forename: K
authors.initials: K
authors.lastname: Staufer
authors.forename: P
authors.initials: P
authors.lastname: Steindl-Munda
authors.forename: A
authors.initials: A
authors.lastname: Gangl
authors.forename: P
authors.initials: P
authors.lastname: Ferenci
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary; D000311:Adrenal Glands / Q000473:pathology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001317:Austria; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D014481:United States
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral