APASL HCV guidelines of virus-eradicated patients by DAA on how to monitor HCC occurrence and HBV reactivation

Tatsuo Kanda, George K.K. Lau, Lai Wei, Mitsuhiko Moriyama, Ming Lung Yu, Wang Long Chuang, Alaaeldin Ibrahim, Cosmas Rinaldi Adithya Lesmana, Jose Sollano, Manoj Kumar, Ankur Jindal, Barjesh Chander Sharma, Saeed S. Hamid, A. Kadir Dokmeci, Mamun-Al-Mahtab, Geoffrey W. McCaughan, Jafri Wasim, Darrell H.G. Crawford, Jia Horng Kao, Yoshihiko OokaOsamu Yokosuka, Shiv Kumar Sarin, Masao Omata

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75 Citations (Scopus)


In the direct-acting antiviral (DAA) era for hepatitis C virus (HCV) infection, sustained virological response (SVR) is very high, but close attention must be paid to the possible occurrence of hepatocellular carcinoma (HCC) and reactivation of hepatitis B virus (HBV) in patients with co-infection who achieved SVR in short term. HCC occurrence was more often observed in patients with previous HCC history. We found occurrence of HCC in 178 (29.6%) of 602 patients with previous HCC history (15.4 months mean follow-up post-DAA initiation) but, in contrast, in only 604 (1.3%) of 45,870 patients without previous HCC history (18.2 months mean follow-up). Thus, in these guidelines, we recommend the following: in patients with previous HCC history, surveillance at 4-month intervals for HCC by ultrasonography (US) and tumor markers should be performed. In patients without previous HCC history, surveillance at 6- to 12-month intervals for HCC including US is recommended until the long-term DAA treatment effects, especially for the resolution of liver fibrosis, are confirmed. This guideline also includes recommendations on how to follow-up patients who have been infected with both HCV and HBV. When HCV was eradicated in these HBsAg-positive patients or patients with previous HBV infection (anti-HBc and/or anti-HBs-positive), it was shown that HBV reactivation or HBV DNA reappearance was observed in 67 (41.4%) of 162 or 12 (0.9%) of 1317, respectively. For these co-infected patients, careful attention should be paid to HBV reactivation for 24 weeks post-treatment.

Original languageEnglish
Pages (from-to)649-661
Number of pages13
JournalHepatology International
Issue number6
Publication statusPublished - 1 Nov 2019


  • DAA
  • Follow-up
  • Guideline
  • HBV
  • HCC
  • HCV
  • SVR


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