Hepatitis C Virus Mediated Hepatocellular Carcinoma: A Focused Review for a Time of Changing Therapeutic Options

Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality, accounting for approximately 600,000 deaths annually world-wide and 10,000 deaths annually in the United States.  Chronic infection with the hepatitis C virus (HCV) is the leading risk factor for HCC in the United States, and the second leading risk factor for HCC world-wide.  The addition to the anti-HCV treatment armamentarium of boceprevir and telaprevir in 2011, and of simeprevir and sofosbuvir in 2013, mark a transition to a new era.  In this new era, treatment for HCV is becoming so highly effective and tolerable that for the first time eradication of chronic HCV on a population level is realistically foreseeable.  A major reduction in the burden of chronic HCV is likely to translate into a substantial reduction in the incidence of HCC.  Here, we review the epidemiology, pathogenesis, and treatment of HCC with a special focus on hepatocarcinogenesis associated with chronic HCV infection.