Directly Acting Antivirals (DAA) do not reduce liver cancer rates in patients who already have cirrhosis of liver
Directly acting antivirals (DAA) may have emerged as the go to drugs for Hepatitis C in recent years – so much so that many state governments now have Hep C eradication programmes using DAA – but the “wonder drug” does not bring down liver cancer rates. This is particularly true for patients who already have cirrhosis of liver.
Take the case of Mr Ray, a top notch executive living in posh Santacruz.
His brother was diagnosed with hepatitis C infection along with cirrhosis of liver 8 months back. He had completed the DAA course against Hepatitis C and had been declared free of the disease causing virus. However, recent follow up reports suggested that his brother has developed a cancer in the liver (hepatocellular cancer) and the best treatment is a liver transplant.
Mr Ray’s brother is by no means, an exception. In fact, many liver transplant surgeons in South Asia have noticed a spike in the number of cases of liver cancer in recent years, especially those who have received DAA. A recent publication from researchers in Barcelona in the prestigious Journal of Hepatology has scientifically supported that theory.
All this changed drastically with the invention of drugs which could be taken orally, and over much shorter course of time. The newer tablets called DAA brought about a paradigm shift in the treatment of hepatitis C. They achieved cure rates of 95% with none of the side effects of previous treatment regimes
Hepatitis C is a virus that is transmitted through blood, mainly through transfusion of contaminated blood or sharing of infected syringes.
The virus damages the liver, and if the damage progresses, it ends up causing cirrhosis of liver. Previously, interferon injections were the mainstay of treatment. However, the treatment was fraught with complications and many people discontinued midway. Even those who completed the full course had sub optimal clearance of virus from the body or even if cleared, the virus came back causing further damage.
One serious effect of the liver damage is the increased risk of liver cancer in infected patients. All this changed drastically with the invention of drugs which could be taken orally, and over much shorter course of time. The newer tablets called DAA brought about a paradigm shift in the treatment of hepatitis C. They achieved cure rates of 95% with none of the side effects of previous treatment regimes.
Many governments including in many Indian states have included these drugs in their programs to eradicate hepatitis C. The benefits can be seen now, when the number of cases of cirrhosis due to hepatitis C requiring liver transplant are showing a downhill trend.
However, the scenario may be different for people who already have cirrhosis (permanent damage to liver) at the time of starting treatment with DAA. Recent research as stated above shows that, though hepatitis C is cured in such patients, they also have similar rates of developing liver cancer compared to those not treated. The jury is still out to decide whether such cancers are due to the drugs or whether the drugs are not good enough to prevent development of liver cancer despite controlling the virus effectively.