Bullseye: direct-acting antivirals are changing the game in hepatitis C and hepatocellular carcinoma

Chronic infection with hepatitis C, a virus affecting over 130 million people around the globe, is responsible for one-quarter of hepatocellular carcinomas (HCCs) as well as half a million annual liver disease-related deaths. The treatment of chronic hepatitis C virus (HCV) infection has been a matter of ongoing concern, as previously investigated treatment options have produced suboptimal rates of sustained virologic response (SVR) in patients with compensated liver function and have been largely unsuccessful in those with decompensated cirrhosis. The arrival of direct-acting antivirals (DAAs) has enabled SVR rates in excess of 90% to be achieved in HCV-infected patients and has catalysed rapid advancement in established treatment regimens. The prohibitive cost of DAAs (in excess of $60,000 USD for 12 weeks of treatment) is the primary barrier to their immediate widespread usage. This article reviews the link between HCV infection and the development of HCC, and compares previous treatment regimens with the recent success of DAAs in terms of successful virus elimination and hepatic transplantation.