Title: Liver cancer risk  and changes in lifestyle habits after successful hepatitis C virus therapy
                                                                               Post-DAA HCV therapy: lifestyle
changes and liver cancer risk
Version: 3 Date: 12 Nov 2024
Reviewer's report:
This is a well-conducted study that clearly informs practicing physicians that patients with
chronic Hepatitis C who achieve a high sustained virologic response (SVR) still remain at risk for
metabolic dysfunction- associated with liver disease (MASLD) and alcohol-related liver disease
(MetALD). The overall incidence of hepatocellular carcinoma (HCC) was low in this cohort,
which limits further analysis for risk stratification in these patients.
Another limitation of the study is that the authors did not address other decompensating events
related to the development of portal hypertension, such as ascites, encephalopathy, or variceal
bleeding, in the study subjects during the 48-month follow-up period.
In addition to obesity, diabetes is a significant risk factor for the progression of MASLD;
however, the overall prevalence of diabetes in this cohort was low. It is well-known that
treatment for Hepatitis C can improve insulin resistance and diabetes control, yet no information
was provided regarding diabetes management during the follow-up period.
The main outcome of the study was the development of hepatic steatosis, but steatosis was
identified in only 6% of patients, which is inconsistent with findings from other epidemiological
studies. The diagnosis of hepatic steatosis was based on ultrasound, which may not accurately
reflect the presence of hepatic steatosis in this population
Title: Liver cancer risk  and changes in lifestyle habits after successful hepatitis C virus therapy
                                                                               Post-DAA HCV therapy: lifestyle
changes and liver cancer risk
Version: 3 Date: 12 Nov 2024
Reviewer's report:
This is a well-conducted study that clearly informs practicing physicians that patients with
chronic Hepatitis C who achieve a high sustained virologic response (SVR) still remain at risk for
metabolic dysfunction- associated with liver disease (MASLD) and alcohol-related liver disease
(MetALD). The overall incidence of hepatocellular carcinoma (HCC) was low in this cohort,
which limits further analysis for risk stratification in these patients.
Another limitation of the study is that the authors did not address other decompensating events
related to the development of portal hypertension, such as ascites, encephalopathy, or variceal
bleeding, in the study subjects during the 48-month follow-up period.
In addition to obesity, diabetes is a significant risk factor for the progression of MASLD;
however, the overall prevalence of diabetes in this cohort was low. It is well-known that
treatment for Hepatitis C can improve insulin resistance and diabetes control, yet no information
was provided regarding diabetes management during the follow-up period.
The main outcome of the study was the development of hepatic steatosis, but steatosis was
identified in only 6% of patients, which is inconsistent with findings from other epidemiological
studies. The diagnosis of hepatic steatosis was based on ultrasound, which may not accurately
reflect the presence of hepatic steatosis in this population
Please review this paper.
user
Title: Liver cancer risk  and changes in lifestyle habits after successful hepatitis C virus therapy
                                                                               Post-DAA HCV therapy: lifestyle
changes and liver cancer risk
Version: 3 Date: 12 Nov 2024
Reviewer's report:
This is a well-conducted study that clearly informs practicing physicians that patients with
chronic Hepatitis C who achieve a high sustained virologic response (SVR) still remain at risk for
metabolic dysfunction- associated with liver disease (MASLD) and alcohol-related liver disease
(MetALD). The overall incidence of hepatocellular carcinoma (HCC) was low in this cohort,
which limits further analysis for risk stratification in these patients.
Another limitation of the study is that the authors did not address other decompensating events
related to the development of portal hypertension, such as ascites, encephalopathy, or variceal
bleeding, in the study subjects during the 48-month follow-up period.
In addition to obesity, diabetes is a significant risk factor for the progression of MASLD;
however, the overall prevalence of diabetes in this cohort was low. It is well-known that
treatment for Hepatitis C can improve insulin resistance and diabetes control, yet no information
was provided regarding diabetes management during the follow-up period.
The main outcome of the study was the development of hepatic steatosis, but steatosis was
identified in only 6% of patients, which is inconsistent with findings from other epidemiological
studies. The diagnosis of hepatic steatosis was based on ultrasound, which may not accurately
reflect the presence of hepatic steatosis in this population
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