Factors predicting hepatocellular carcinoma in hepatitis C infection

Abstract

Hepatitis C virus (HCV) has emerged as a leading cause of hepatocellular carcinoma (HCC). In most cases, the virus causes HCC in the presence of chronic hepatic inflammation, advanced fibrosis, and cirrhosis. A combination of viral, environmental, and genetic factors are likely to determine the host immune response to the infection as well as the progression to HCC. Clinical and epidemiologic studies have identified many of the risk factors associated with HCC development in patients with chronic hepatitis C. Male sex and older age are considered as independent risk factors for HCC, while alcohol consumption accelerates fibrosis, increasing the risk for progression to HCC. Obesity, diabetes mellitus, nonalcoholic fatty liver disease, aflatoxin exposure and occult hepatitis B infection, all contribute to a higher HCC risk. HCV patients infected with HCV genotype 3 are also more likely to develop HCC and genetic variations such as single nucleotide polymorphisms, which may also alter the risk. Sustained virological response to the antiviral therapy results in significantly more favorable long-term outcomes. The incidence of HCC after HCV eradication is similar between patients treated with peginterferon plus ribavirin and direct-acting antiviral therapy.

Risk Factors Associated With Development of Hepatocellular Carcinoma in Hepatitis C Virus Patients

“…Age and gender are independent risk factors for HCC patients with HCV infection. HCC represents the third most popular malignancy among men and 7th among women worldwide [8]. Men have a greater threat of HCC than women due to their exposure to other risk factors such as alcohol abuse, smoking plus persistent HCV or HBV infection [9].…”

“…HCV infection rates have been shown to be significantly higher in alcoholic patients than in nonalcoholic ones [ 8 ]. Furthermore, alcohol consumption in chronic HCV patients has been associated with an accelerated rate of fibrosis and a higher risk of development of liver cirrhosis and eventually HCC [ 13 ].…”

“…HCV-infected individuals who are obese, have diabetes mellitus (DM), and/or have nonalcoholic fatty liver disease (NAFLD) are more likely to develop HCC [8]. Around 25% of the global population are affected by NAFLD, among those 60% are affected by non-alcoholic steatohepatitis (NASH), evolving HCC at a rate of 5.29/1000 person per year [14].…”

“…Genetic alterations like SNPs, might change the disease risk and hence may be applied as predictive markers of the disease outcome. To that end, SNPs are useful indicators of the increased risk of HCC [ 8 ]. Accumulated data suggest a relationship between SNPs of certain genes and the vulnerability to HCC.…”

Influence of IL28B of Donors and Recipients on Liver Transplantation Due to End Stage HCV Related Liver Disease

“…As there are similarities between re-infection of a 1307 graft with HCV after LT and the pretransplant course of infection with HCV, we postulated that genetic variants of IL-28B may play a role in the development of HCV-related graft disease and its response to treatment. The best baseline predictors of response to HCV therapy are infection with HCV genotypes 2 or 3, low baseline serum HCV RNA level, and null-minimal liver fibrosis [9] . Once treatment has been initiated, the best predictor of cure is the achievement of undetectable serum HCV RNA level at week 4 [10] .…”