Between 2015 and 2017, 118 HIV/HCV coinfected patients with advanced liver disease (METAVIR F3-F4 on transient elastography), without history of HCC and no evidence of focal liver lesions started treatment with direct-acting antivirals (DAAs) for 12 or 24 weeks. The authors found that sustained virologic responses (SVR) were achieved in 97% of patients by post-treatment week 12. During standard surveillance de novo hepatocellular carcinoma (HCC) was diagnosed in 2.5% of patients with advanced liver disease at 20, 36 and 61 weeks following beginning of anti-HCV treatment. Two patients were in stage A and one patient was in stage B. All three patients had liver cirrhosis, were infected by genotype 3 and were treated with daclatasvir, sofosbuvir and ribavirin for 24 weeks, achieving SVR. Two of them had an increase in AFP level, while a decreasing trend of AFP levels was seen in patients without de novo HCC during DAAs-based therapy. This suggests that HCV genotype 3 patients may need more comprehensive HCC surveillance, even if they achieve SVR on DAA-therapy.
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