Section of Gastroenterology, DIBIMIS, University of Palermo, 90127, Palermo, Italy.
Direct acting antivirals (DAAs) stabilize or improve liver function in the majority of patients with HCV cirrhosis. Hepatic decompensation is the main driver of death of patients with early, successfully treated HCC superimposed to cirrhosis. Treatment with DAAs could improve the prognosis of these subjects, independently from the subsequent course of HCC, if the efficacy in obtaining viral clearance is as high as in patients without a history of HCC, and if the risk of HCC recurrence is unaffected. When dealing with HCC patients, DAAs can be indicated in two different settings: a) subjects in which HCC has been already successfully treated ("cured" HCC), or b) subjects whose HCC is still untreated or untreatable ("active" HCC). While there are abundant data on "cured" HCC, evidence supporting treatment decisions in patients with "active" HCC is at best scarce and controversial, since these patients as well as patients with HCC listed for liver transplantation (LT) are usually excluded from treatment.