Antiviral therapy in patients with viral hepatitis and hepatocellular carcinoma: Indications and prognosis

Background: Chronic hepatitis B and C infections represent major risk factors for the development of hepatocellular carcinoma (HCC). Recently, the management of patients with viral hepatitis has dramatically changed. In the present review we discuss the impact of these developments on the prevention of HCC as well as the treatment of patients with HCC. Methods: Studies indexed in Medline between 1990 and 2015 (November) were reviewed. The terms 'hepatocellular carcinoma', 'HCC', 'hepatitis B', 'hepatitis C', 'viral hepatitis', and combinations of these terms were used. Results: Patients with chronic hepatitis B or hepatitis C without HCC should be evaluated for antiviral therapy, since antiviral therapy was suggested to reduce the risk of HCC development. Cirrhotic patients infected with hepatitis B virus (HBV) require antiviral therapy, while cirrhotics infected with hepatitis C virus (HCV) need to be prioritized for therapy with interferon (IFN)-free regimens. Antiviral therapy should be considered in HBV-infected patients with HCC, especially to prevent tumor recurrence after curative-intended therapy or to prevent hepatic decompensation. HCV-infected patients with HCC should be considered in similar intention for IFN-free antiviral therapy, depending on the tumor stage and life expectancy. Conclusion: Patients with viral hepatitis should be considered for antiviral treatment for the prevention of HCC development as well as during HCC treatment.