Background: Direct-acting anti-viral drugs (DAAs) have become widely used for cirrhotic patients with hepatitis C infection. Virological responses are excellent with SVR rate in > 90% of cirrhotic patients. The association between the use of DAAs and the development of hepatocellular carcinoma (HCC) is debatable.
Aim of the work: investigate the incidence of HCC and characteristics of tumors after DAAs therapy.
Patients and methods: A prospective study of a cirrhotic patient with chronic hepatitis c virus who received 12 weeks of DAAs therapy (sofosbuvir, daclatasivir) in Mansoura specialized medical hospital and followed up for 6 months post-treatment. Untreated cirrhotic patients with hepatitis C infection for comparison.
Results: amongst (27/30) 90% of patients achieved sustained virological response 12 weeks post-treatment there were 3/30 (10%) not responded, and 7/30 from treated patients vs 11/30 untreated patients had de novo HCC.              
Conclusion: DAAs reduced the incidence of HCC but with no significant difference with the untreated patient (refuse treatment) after six months, however, the pattern of tumor characteristics is very aggressive in the treated patient.