Hepatocellular Carcinoma in Hepatitis C-Associated Cirrhotic Patients Treated with Different Combinations of Direct-Acting Antiviral Agents Available in Pakistan: A Prospective Observational Study

Background: The hepatitis C virus (HCV) is a leading cause of chronic liver disease, including hepatic cirrhosis and hepatocellular cancer (HCC). Drugs that act directly on the virus, like as direct-acting antivirals (DAAs), are associated with improved long-term virologic responses and reduced treatment time. Pakistani patients with HCV-related cirrhosis receiving DAA medication were studied to see if they had an increased risk of hepatocellular carcinoma (HCC). Material and Methods: We conducted a prospective observational study at Isra University Hospital Hyderabad from July 2019 to August 2020. Three hundred fourteen patients met the inclusion criteria and were included. We recorded baseline demographic characteristics, Child-Pugh class, model for end-stage liver disease (MELD) score, alpha-fetoprotein level, and abdominal ultrasound/computed tomography (CT) scan before and after treatment. Results: Three hundred-fourteen individuals took part in the research. The average age of participant with hepatocellular carcinoma was 46.7 years. Twenty (sixty-nine) of the participants developing hepatocellular carcinoma were men, while nine (thirty-one percent) were women (p=0.221). Five (17.2%) of the HCC participants were diabetics, and seventeen (58.6%) were tobacco users (p=0.001). Twenty individuals (69%) developed HCC after receiving a combination of sofosbuvir and daclatasvir. A sofosbuvir/velpatasvir combination led to the development of HCC in nine (31%) of individuals (p=0.1). HCC was diagnosed in eight individuals under the age of forty (27.6%), but in 21 patients beyond the age of forty (72.6%) (p=0.55). HCC was found in 65.6 percent of Child-Turcotte-Pugh class A participants. Conclusion: DAAs have been linked to a higher risk of HCC. Participants receiving a combo of sofosbuvir/daclatasvir were more likely to develop HCC than those who received sofosbuvir/velpatasvir alone. Keywords: Velpatasvir, Hepatocellular carcinoma, Sofosbuvir, Cirrhosis