Direct-acting antiviral (DAA) therapy has revolutionized the treatment of hepatitis C virus (HCV) infection, with very high rates of sustained virologic response (SVR) and an excellent safety profile.1,2 Interferon-based therapies in the past have shown improved outcomes, including reduced risk for occurrence and recurrence of hepatocellular carcinoma (HCC) with the achievement of SVR.3 However, data on the impact of DAA therapy on the natural history and development of HCC are limited. Recently, studies have shown unexpected high HCC recurrence rate of 27%-29% among patients treated with resection or ablation, who received DAA therapy.