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. 2019 Sep 23;10(1):43–80. doi: 10.1016/j.jceh.2019.09.007
Consensus statements Level Grade
  • Patients who have cirrhosis due to hepatitis C or hepatitis B have the highest rate of developing HCC as compared with chronic hepatitis or cirrhosis due to other etiologies.

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  • In non-cirrhotic patients with chronic hepatitis B virus infection:
    • HBeAg positivity carries higher risk of developing HCC compared with HBeAg negativity.
    • HBeAg negativity carries higher risk of developing HCC compared with general population.
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  • In non-cirrhotic patients with chronic hepatitis C virus infection:
    • HCC is most often associated with advanced fibrosis however in up to 10% of cases, and it may occur even with mild degrees of fibrosis.
    • Anti-HCV positivity is associated with higher risk of developing HCC than general population.
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  • In patients with HBV- or HCV-related chronic liver disease the risk of HCC is increased if there is concomitant:
    • HIV co-infection
    • HBV/HCV co-infection
    • Chronic alcohol abuse
    • Obesity
    • Diabetes mellitus
    • Aflatoxin exposure
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  • In Indian HBV patients, HCC is more often associated with:
    • HBV genotype D infection/mixed genotype infection
    • High HBV DNA levels (>10,000 copies/mL)
    • Persistently elevated serum ALT levels
    • High level of hepatitis B surface antigen
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  • In Indian HCV patients, HCC is more often associated with:
    • HCV genotype 4 infection
    • High serum HCV RNA levels
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  • Chronic alcohol consumption is an important risk factor for HCC development.

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  • Obesity, diabetes mellitus, and non-alcoholic fatty liver disease are important risk factors for HCC development.

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  • Regarding HCV patients treated with DAA:
    • There is no difference in occurrence or recurrence of HCC post-SVR in patients treated with IFN or DAA.
    • Cirrhosis, low albumin, low platelet, and AFP level posttreatment are indicators of high HCC occurrence even after SVR.
    • Long-term follow-up studies are required to assess surveillance strategy in patients treated with DAA.
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