The improvement in Hepatitis C treatment success marks a dramatic
change in the prognosis for most Hepatitis C diagnoses. New
direct-acting antiviral drugs boast viral eradication rates in the high
90th percentile, rendering hope that the Hepatitis C virus can be
eradicated. Until recently, the only major obstacle surrounding these
Hepatitis C medications has been their outrageously high cost. However, a
large-scale prospective study has revealed a surprising caveat –
revealing that the direct-acting antiviral drugs for Hepatitis C may not
be the panacea the medical community had been hoping for.
all potent medications, the drugs used to eliminate Hepatitis C are
likely to have side effects. Prior to 2014 when direct-acting antiviral
drugs started getting approved by the U.S. Food and Drug Administration,
the drugs used to treat chronic Hepatitis C had many severe side
effects. Thankfully, the newer Hepatitis C treatments have fewer and
milder side effects.
The most common adverse reactions to direct-acting antiviral medications for Hepatitis C include:
- Skin Rash/Itching
none of the side effects listed above are pleasant, they are certainly
minimal when evaluating their potential benefit of eradicating Hepatitis
C. That was true until an Italian researcher presented results of his
study at the American Association for the Study of Liver Diseases
(AASLD) annual 2016 Liver Meeting in Boston, MA.
According to lead
investigator Alfredo Alberti, MD, professor of gastroenterology at the
University of Padova in Italy, direct-acting antiviral drugs could
worsen liver cancer. If future investigations into this association
support Alberti’s results, direct-acting antiviral drugs may present
more hazard than benefit to our health. Some details from Alberti’s
- Dr. Alberti and colleagues followed over 3,000
patients with Hepatitis C infection for an average of 300 days after
beginning direct-acting antiviral therapy.
- Direct-acting antiviral drugs do not appear to increase liver cancer risk for people with Hepatitis C and cirrhosis.
- Direct-acting antiviral drugs appear to make previously undetected cancers worse and harder to treat.
percent of those studied who developed a tumor early during Hepatitis C
treatment or just after stopping treatment developed a more aggressive
type of tumor than what is typically seen.
- The severity of
hepatocellular carcinoma (primary liver cancer) seemed to correlate with
the antiviral therapy over a 540-day follow-up period.
incidence rates of liver cancer were no different in those who received
direct-acting antiviral therapy and those who did not receive the
- Alberti and his colleagues hypothesized that when viral
replication is halted, dramatic changes in the immunologic and
molecular microenvironment occur in the liver, which impact tumor
suppression mechanisms. This change allows or promotes the growth of
previously undetected liver cancer cells.
putting Alberti’s conclusion into a larger perspective, valuable
information in the battle against Hepatitis C is gleaned. Just like the
need for physical therapy to help someone recover from orthoscopic knee
surgery, a rehab for liver health may be necessary following Hepatitis C
After the presentation of this large-scale
study, more investigation into the risk of liver cancer growth
acceleration from direct-acting antiviral medications for treating
Hepatitis C is warranted. Until a definitive conclusion is drawn,
Alberti’s work sends two clear signals.
- One, patients with
Hepatitis C who receive treatment with direct-acting antiviral
medications must be monitored for hepatocellular carcinoma.
- Two, even if the Hepatitis C virus has been eliminated, liver monitoring and care must persist.
the virus has been the goal of Hepatitis C treatment since the
infectious agent was first identified. However – Alberti’s study brings a
larger picture into focus – the overall health of the liver. Viral
eradication without severe side effects may only be step one of treating
Hepatitis C. The second step may be finding ways to return the liver to
a healthy microenvironment.
Hepatitis C Treatment Side Effects, Retrieved November 13, 2016, Smart + Strong, 2016.
Direct-Acting Antivirals for Hep C Might Worsen Liver Cancer, Neil Osterweil, Retrieved November 13, 2016, WebMD, LLC, 2016.