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Impact of Hepatitis C Virus Infection on Hepatocellular Carcinoma. Hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) incidence in the United States is increasing, partly because of risk factors such as diabetes, fatty liver, hepatitis B virus, and human immunodeficiency virus coinfection. Achieving sustained virologic response (SVR) is the most significant factor in reducing HCV-associated HCC incidence. Improved SVR with the next generation of direct-acting antivirals brings hope for decreased HCC mortality. Nevertheless, surveillance for HCC remains important because HCC can still occur despite SVR, especially in cirrhotics. Individualized risk stratification through increased understanding of HCC pathogenesis and improved surveillance holds the promise for future reduction of HCC incidence.