Hepatocellular carcinoma and hepatitis C virus: which should be treated first?

Hepatitis C virus (HCV) cure before hepatocellular carcinoma (HCC) treatment is especially relevant for those patients in the early stage of the Barcelona Clinic Liver Cancer (BCLC) classification. Indeed, a major advantage with HCV cure before liver transplantation is the prevention of posttransplant HCV recurrence. Antiviral treatment of HCV after a cure of HCC is recommended by professional liver societies, owing to the fact that advanced hepatitis C complicated by liver cancer poses a substantial risk of lethal clinical decompensation if treatment of infection is deferred whereas the suppression of liver inflammation is thought to enhance the risk of developing de novo HCC. Direct-acting antiviral therapy also appears to be safe in waitlisted patients who underwent either bridge therapy or downstaging with locoablative techniques, where HCV eradication proved to be clinically advantageous.