1Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.
2Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany German Center for Infectious Diseases (DZIF), Hannover-Braunschweig, Germany.
Hepatitis C infection represents a global health problem affecting approximately 200 million chronically infected patients worldwide. Due to the development of a fibrogenic and inflammatory micromilieu in the liver, HCV-infected patients are at high risk of developing fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The advent of direct-acting antiviral agents (DAA), however, has spurred a revolution in the treatment of HCV patients with sustained viral response (SVR) rates exceeding 90% in real-life settings. Recent clinical trials suggest that these novel treatments will not only alter the epidemiology of HCV infection but also the incidence of HCV-induced complications including hepatic decompensation, liver transplantation and hepatocarcinogenesis. Here we summarize data from clinical trials performed in HCV-patients with compensated and decompensated cirrhosis and analyze the impact of viral clearance on HCC development and treatment. Finally, we review and discuss current and future treatment options of HCV patients with HCC in pre- and post-transplantation settings.