Given the heterogeneity of these studies with respect to patient populations and performance status, the small numbers of patients studied in some groups, and the fact that HBV-related HCC is more lethal than HCV-related HCC, the impact of cancer therapy in HCV-related versus HBV-related HCC merits further study. HCV contamination should be assessed by an expert to evaluate liver disease severity, comorbidities associated with HCV contamination, and treatment opportunities. DAA therapy should be tailored on the basis of patient prognosis, type of cancer, cancer treatment plan, and hepatic and virologic parameters. HCV-infected cancer patients with cirrhosis (or even advanced fibrosis) and those at risk for liver disease progression, especially patients with HCV-associated comorbidities, should have ongoing follow-up, regardless of Silicristin whether there is a sustained virologic response, to ensure timely detection and treatment of HCC. HCV contamination and its treatment should not be considered contraindications to cancer treatment and should not delay the initiation of an urgent malignancy therapy. ideally in a liver transplant centerProvision of careFrequently requires a transdisciplinary teamFrequently managed by single provider Open in a separate windows DAA, direct-acting antiviral; HCT, hematopoietic cell transplant; HCV, hepatitis C computer virus The burden of HCV in patients with cancer and the inconclusive evidence regarding detection and management of HCV contamination in patients with cancer prompted us to review the literature and to summarize the available data on HCV epidemiology and Rabbit Polyclonal to OR13F1 risk factors; associations between HCV and cancer; the carcinogenic potential of HCV; HCV screening; complications of HCV contamination, and treatment of HCV contamination, including with the use of new DAAs. We searched PubMed and Web of Science for articles published from January 1, 1966, through March 24, 2017, using the terms hepatitis C computer virus, HCV, prevalence, screening, malignancy, chemotherapy, and reactivation. We also searched the reference lists of articles identified by this search strategy and selected those recommendations we judged relevant for each specific issue discussed. Abstracts were included only when they related directly to subsequently published work. We used the Grades of Recommendation, Silicristin Assessment, Development and Evaluation (GRADE) system to grade the quality of evidence.16 Global epidemiology of HCV contamination The main mode of transmission of HCV was the use of contaminated medical materials. In high-income countries, widespread use of shared needles for medical treatments led to an epidemic of HCV contamination in the 1940s. In the United States, contaminated blood products were also a mode of transmission of HCV contamination before July 1992. Intravenous drug use has been and is still a leading contributor to the epidemic of HCV contamination worldwide. 17,18 In low-to-middle-income countries, iatrogenic factors are still key contributors to the epidemic of HCV contamination. Estimates of the prevalence of HCV antibodies worldwide range from 1.6%19 to 2.8%.20 The highest prevalences are reported in low-income countries, including Egypt (15%), Pakistan (4.7%), and Taiwan (4.4%)21; prevalences are lower in North America (1.1%C1.3%), Australia (1.7%), and Eastern and Western Europe (0.5%C4.5%).19 The latest epidemiologic reports suggest that there are currently 80 million HCV-RNA-positive individuals around the globe.19,22 In the United States, it is estimated that at least 3.5 million people (range, 2.5 million to 4.7 million) live with HCV infection23 and that about half of them are unaware they are infected.24 Individuals born during 1945C1965 have a 3% prevalence of HCV antibodies, which is five occasions the prevalence in adults born in other years.25 Natural history of HCV infection HCV infection evolves to chronic infection in more than two-thirds of cases, and 4% to 25% of patients with chronic HCV infection develop cirrhosis within 20 to 30 years after HCV infection is first diagnosed.26 Once cirrhosis develops in a patient with chronic HCV infection, the risk of hepatocellular carcinoma (HCC) is estimated to Silicristin be 1% to 4% annually, similar to the risk of end-stage.