Hepatocellular Carcinoma in Patients with Chronic Hepatitis C After Achieving Sustained Virological Response: Case Reports

The article presents two clinical observations demonstrating the persistent risk of hepatocellular carcinoma in patients with chronic hepatitis C after achieving sustained virological response. In the first case, a patient from the Republic of Tyva with pre-existing liver cirrhosis (F4) developed hepatocellular carcinoma after long-term virus persistence and late sustained virological response. Fibrosis regression (F4–F2) and normal alpha-fetoprotein levels contributed to the lesions being interpreted as adenomas, leading to a three-year delay in diagnosis verification. In the second case, a patient from St. Petersburg with HIV/HCV coinfection developed hepatocellular carcinoma one year after achieving sustained virological response. The final diagnosis (hepatocellular carcinoma) was established only at autopsy, whereas cholangiocarcinoma had been suspected during life. Portal vein tumor thrombosis was identified, which was complicated by fatal bleeding from esophageal varices. These observations indicate the need for lifelong follow-up in patients with chronic hepatitis C, especially in those with pre-existing cirrhosis and HIV coinfection. Any newly detected hypervascular liver lesion in this patient category should be considered potentially malignant until proven otherwise.

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