Hepatitis C virus (HCV) infection affects over 130 million individuals worldwide, and it is the number 1 reason for liver transplantation in the United States. HCV infection progresses in a slow chronic fashion eliciting a strong but ineffective immune response, mainly characterized by NK cell dysfunction and T cell exhaustion. The chronic hepatic inflammation leads to liver fibrosis, cirrhosis and cancer in a significant number of patients. In recent years, groundbreaking research has led to the discovery of new HCV-specific direct acting antivirals (DAAs), which have an unprecedented efficacy to clear the virus, and establish a sustained virological response. Indeed, curing HCV infection with an oral medication is now reality. The effects of DAAs in mitigating the HCV-related complications of liver fibrosis and cancer are yet largely unknown. Nonetheless, recent controversial reports suggest a potential increase in liver cancer recurrence upon use of DAAs. In the current manuscript we review the most important immune-mediated mechanisms underlying HCV chronicity and the development of liver fibrosis and cancer. Furthermore, we discuss recent concern on use of the new agents.

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Persistent URL dx.doi.org/10.1097/TP.0000000000001623, hdl.handle.net/1765/95340
Journal Transplantation
Debes, J.D, de Knegt, R.J, & Boonstra, P.A. (2017). The path to cancer, and back: Immune modulation during hepatitis C virus infection, progression to fibrosis and cancer, and unexpected roles of new antivirals. Transplantation (Vol. 101, pp. 910–915). doi:10.1097/TP.0000000000001623