Association between metabolic associated fatty liver disease and HCC risk after SVR in HCV patients: a systematic review and meta-analysis

Aim of the study:
Chronic hepatitis C (CHC) infection remains one of the most prevalent chronic liver disease worldwide. A sustained virological response (SVR) can be achieved at high rates for CHC patients receiving direct-acting antivirals (DAAs). However, even small subsets of patients achieving SVR still have a risk of developing hepatocellular carcinoma (HCC). Metabolic-associated fatty liver disease (MAFLD) is associated with increased risk of HCC. We aimed to summarize the effect of MAFLD on HCC development on CHC patients, even after achieving SVR.

Material and methods:
We conducted a search of PubMed and Google Scholar from inception to July 7^th 2024, for studies assessing the association between the presence of MAFLD or metabolic dysfunction-associated steatotic liver disease (MASLD) or non-alcoholic fatty liver disease (NAFLD) and HCC risk in CHC patients who achieved SVR. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). We analyzed the pooled hazard ratios (HRs) with 95% confidence intervals (CIs) using a fixed and random-effects model. Heterogeneity was assessed using I².

Results:
Five studies with a total of 7,034 patients were included. The quality of studies ranged from 6 to 8 stars. Metabolic dysfunction is associated with increased risk of HCC after SVR in CHC patients (HR = 2.02, 95% CI: 1.61-2.54, p < 0.00). No heterogeneity was present.

Conclusions:
Metabolic dysfunction is associated with increased risk of HCC progression in CHC patients even after achieving SVR.