Optimum initiation-time of direct-acting antivirals for hepatitis C after curative ablation of hepatocellular carcinoma improves neoplastic recurrence-free survival

Background: Early initiation of direct-acting antivirals (DAAs) after ablation of hepatocellular carcinoma (HCC) may boost the proliferation of the potentially present extra-lesion dormant neoplastic micro-nodules. Aim: We evaluated the performance of early initiation of DAAs therapy after curative ablation of HCC as a risk factor for early neoplastic recurrence in chronic hepatitis-C patients, aiming to select an optimum initiation time for DAAs therapy. Materials and Methods: This retrospective cohort study was conducted at hepatology unit at Tantauniversity Hospitals in the period from January 2016 to January 2020 on 142 naive HCV patients who achieved SVR to DAAs therapy after complete ablation response of HCC. Post-ablation to DAAs-initiation elapsed time window were estimated. All patients were followed up regularly for 18 months from completion of DAAs therapy for the ascertainment of HCC recurrence. Results: HCC recurrence occurred in 27.5% of our patients, most of them (43.6%) in the first 6 months post-DAAs therapy with an incidence rate of 1 per100 persons-months. Post-ablation to DAAs-initiation time window had a significant performance as a risk factor for early HCC recurrence after DAAs therapy (AUROC:0.8887; CI:0.821-0.953; sig:0.000), the tenth month of post-ablation time was the most accurate cutoff value for ruling out HCC recurrence for values more than it (sensitivity: 97.4%, LR-:0.09). Conclusions: Early DAAs-initiation after curative HCC ablation seems to be a significant risk factor for early HCC recurrence; DAAs-initiation should be delayed after 10 months.