Direct‐Acting Antiviral Therapy in Patients With Hepatocellular Carcinoma Receiving Non‐Curative Treatment: High Sustained Virological Response Rates and Preservation of Liver Functional Reserve

ABSTRACT Direct‐acting antivirals (DAAs) cure most chronic hepatitis C virus (HCV) infections, but their impact on liver functional reserve in patients with a history of hepatocellular carcinoma (HCC), particularly after non‐curative HCC treatment, remains unclear. We evaluated antiviral efficacy and liver functional reserve after DAA therapy according to HCC history and timing of DAA initiation. In this retrospective single‐center cohort, 716 patients initiated DAA therapy, and 690 with evaluable sustained virological response at 12 weeks after treatment (SVR12) were analysed. Patients were classified as no HCC, curative‐treated HCC, or non‐curative‐treated HCC according to the most recent HCC treatment before DAA initiation. Liver functional reserve was assessed using the albumin–bilirubin (ALBI) score, modified ALBI grade, and Child–Pugh class. In the non‐curative‐treated HCC group, early (≤ 3 months) versus delayed (> 3 months) DAA initiation after the most recent HCC treatment was compared. Overall SVR12 was 96.1%, with similarly high rates across groups regardless of HCC history. The median ALBI score improved from −2.35 to −2.58 at SVR12 in the curative‐treated HCC group ( p  p  < 0.001), and more than 90% remained Child–Pugh class A. Early and delayed DAA initiation showed similarly high SVR12 rates and comparable liver functional reserve. DAAs achieved high SVR12 rates and maintained liver functional reserve in patients with HCV, including those with a history of HCC after non‐curative treatment.