Pancreatic cancer risk in hepatitis C virus infection in the era of Direct Acting Antiretroviral Agents (DAAs)

Background: Egypt used to be the country with the highest prevalence of hepatitis C virus (HCV) infection in the world. But now it is on the way to eliminate HCV by the efforts national Egyptian campaign programs to treat population by direct acting antiretroviral therapy (DAAs). HCV was found to be related to many extra hepatic malignancies like pancreatic cancer. In the era of DAAs, it was expected to find a drop in hepatocellular carcinoma (HCC) cases, but controversial results were found about the role of DAAs in changing cancer risk in chronic hepatitis C (CHC) patients. Limited data is available about DAAs role in extrahepatic malignancy risk. Methods: This is a retrospective case control study that included 76 pancreatic cancer patients admitted to medical oncology department in the period (2023 -2024) and 100 age and sex matched controls. Patients were serologically tested for HCV and HBV and results were confirmed by PCR. Patients are grouped according to the history of DAAs treatment. Results: Untreated HCV patients showed 3.5 fold increase in pancreatic cancer risk than HCV negative controls (p value 0.028). Patients who were treated from CHC by DAAs and achieved sustained virological response had no significant increase in pancreatic cancer risk. Patients with liver cirrhosis showed 7.1 fold increase in pancreatic cancer risk (p value 0.032). Conclusion: CHC is significantly associated with pancreatic cancer but treatment of chronic hepatitis C virus with DAAs was not associated with increase in pancreatic cancer risk.