NHF Screening for Development of Hepatocellular Cancer in Patients with Hepatitis B and C Guideline Summary

Recommendations

All patients with known HCV or HBV infection should have an indirect test for liver fibrosis.
Patients with hemophilia and hepatitis C who have documented cirrhosis should be screened for the development of hepatocellular cancer (HCC).
Patients with hemophilia who have hepatitis B infection and are not cirrhotic should be screened for the development of hepatocellular cancer (HCC) in specific cases based on age, gender, and ethnicity. https://www.aasld.org/practice-guidelines/chronic-hepatitis-b
Patients with hemophilia who have NASH and/or advanced fibrosis (F3 on the Metavir fibrosis scale) but are not cirrhotic should be screened for the development of hepatocellular cancer (HCC).
Screening for HCC should be done at 4 to 8-month intervals. There is no need to change the frequency of the screening examinations for patients with a higher risk of HCC.
Patients with cirrhosis who have been treated and have cleared the hepatitis C virus should also continue to be screened to determine the amount of fibrosis with elastography and/or specialized blood tests annually until their liver fibrosis has improved to the point that they are no longer cirrhotic. This improvement in fibrosis is anticipated but does not always happen. Improvement in fibrosis may take years to reach the point where the risk of HCC is minimal and HCC screening is no longer warranted.

Based on guidelines from AASLD and the AGA (references below) these patients should be screened for HCC:

All patients with cirrhosis, regardless of the cause of their liver disease
Patients with NASH and stage 3 fibrosis (Metavir scale)
Patients with hepatitis B who meet certain age, gender and ethnicity characteristics:

Screening for Development of Hepatocellular Cancer in Patients with Hepatitis B and C