Circulating IL-13 Is Associated with De Novo Development of HCC in HCV-Infected Patients Responding to Direct-Acting Antivirals

SIMPLE SUMMARY: Chronic hepatitis C virus infection is one of the major risk factors for the development of hepatocellular carcinoma. New direct-acting antivirals substantially improved the cure rate of hepatitis C, but the incidence of hepatitis C virus-related hepatocellular carcinoma remains high. To identify the immune profile associated with the risk for hepatocellular carcinoma, we investigated a cohort of patients who developed de novo hepatocellular carcinoma following direct-acting antiviral treatment in comparison to controls who did not develop hepatocellular carcinoma. Our results can improve clinical management prior to the development of hepatocellular carcinoma. ABSTRACT: Direct-acting antivirals (DAAs) are highly effective in targeting hepatitis C virus (HCV) infections, but the incidence of HCV-related hepatocellular carcinoma (HCC) remains still high. In this study, we investigated a cohort of HCV-infected patients treated with DAAs who were followed up for 4 years after sustained virological response (SVR) achievement. Patients who developed de novo HCC following DAA treatment were compared to matched controls who did not develop HCC. These control patients were selected based on DAA treatment, sex, age, fibrosis status, and platelet counts. We evaluated serum levels of 30 immune mediators before, during, at the end of, and three months after DAA treatment using Luminex technology. We identified the immune factors associated with de novo HCC occurrence following DAA treatment. Specifically, interleukin (IL)-4 and IL-13 levels were significantly higher before start of the DAA treatment in the serum of patients who later developed HCC than in controls and stayed higher at each subsequent time point. Least absolute shrinkage and selection operator (LASSO) regression revealed IL-13 as the only strong factor associated with HCC development in this cohort of HCV patients. The difference was observed already at baseline of DAA treatment, which confirms the existence of a specific immune profile in these patients who later develop HCC.