Background: Data on the occurrence of hepatocellular carcinoma (HCC) in decompensated cirrhosis following direct-acting antiviral agents (DAAs) remains insufficient. This study aimed to establish the incidence of HCC in patients with sustained virologic response (SVR) following DAA therapy in chronic hepatitis C (CHC) related decompensated cirrhosis. Materials and methods: This prospective multicenter observational cohort study included 305 HCV patients with decompensated liver cirrhosis without HCC. Patients were divided into two groups. The treatment group included 216 patients who received DAAs while the non-treatment group included 89 patients who refused antiviral therapy. Patients were followed up for at least one year after achieving SVR. In the present study, 230 patients ( 176 in treated group and 54 in non-treated group) continued the study follow-up period of at least one year. SVR was achieved in 90% of patients. Results: Nine patients (5.1%) in the treatment group and 6 patients (11.11%) in non-treatment group developed HCC during the one-year follow-up period after SVR. DAAs therapy was shown to had no significant effect on reducing of incidence of HCC when compared to non-treated patients (p=0.118), although the treatment group showed significant improvement regarding liver function, INR, creatinine, Child-Turcott-Pugh and MELD scores, variceal bleeding, hepatic encephalopathy and ascites when compared to the non-treatment group at one-year post-treatment. Conclusions: treatment of HCV-related decompensated liver cirrhosis with DAA therapy does not reduce the incidence of HCC after one year of follow-up in spite of patients achieving excellent SVR response and showing significant reduction in cirrhosis-related complications.