While clearing Hepatitis C virus (HCV) marks a major milestone, Metabolic Associated Steatotic Liver Disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), emerges as a stealth driver of Hepatocellular Carcinoma (HCC) risk that demands renewed clinical vigilance.
Recent real-world evidence from an analysis of MASLD's impact reveals that patients who achieve sustained virologic response remain vulnerable to HCC if underlying metabolic dysfunction persists. As general practitioners and hepatologists broaden their focus beyond viral eradication, the interplay between insulin resistance, visceral adiposity and liver carcinogenesis commands attention in post-cure surveillance.
Metabolic dysregulation—particularly obesity, dyslipidemia and type 2 diabetes—accelerates fibrosis and fosters a pro-inflammatory hepatic milieu. Data underscores how elevated body mass index and atherogenic lipid profiles are associated with a twofold increase in HCC incidence compared with metabolically healthier counterparts. These findings position cardiometabolic assessment as integral to long-term liver disease management after viral clearance.
Consider a 62-year-old patient who, despite undetectable HCV RNA for four years, developed subcentimeter liver lesions on routine imaging. Persistent steatotic changes on controlled attenuation parameter (CAP) imaging and poorly controlled dyslipidemia signaled MASLD-driven carcinogenesis before radiographic progression. This case highlights that surveillance protocols must evolve to integrate metabolic health metrics alongside traditional fibrosis staging.
Multidisciplinary strategies targeting weight reduction, dietary modification and structured exercise have demonstrated measurable declines in hepatic steatosis and fibrosis progression, translating into lower HCC incidence rates—a principle reflected in earlier findings on lifestyle strategies. Pharmacotherapies addressing insulin sensitivity and lipid abnormalities further complement lifestyle efforts, aligning with the earlier exploration of preventive strategies that advocate for agents such as pioglitazone or statins to mitigate MASLD-related cancer risk.
Embedding metabolic risk counseling into post-HCV care pathways ensures that patients receive comprehensive interventions. Routine measurement of waist circumference, fasting insulin and lipid panels can flag those at highest risk, prompting early referrals to nutritionists and endocrinologists. Adapting surveillance intervals to account for MASLD severity may enable earlier tumor detection and improved outcomes.
Key Takeaways:- Metabolic Associated Steatotic Liver Disease (MASLD) continues to pose a significant HCC risk even after Hepatitis C cure.
- Obesity, dyslipidemia and insulin resistance drive liver inflammation and fibrotic remodeling, heightening post-cure HCC incidence.
- Structured weight management and exercise programs yield reductions in steatosis and may lower HCC rates.
- Pharmacological agents targeting metabolic dysfunction should be integrated with lifestyle measures in post-HCV follow-up.