Although attainment of a sustained virologic response (SVR) reduces the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV) infection, increased risk of HCC remains.1 In the largest series to date, risk factors associated with persistent HCC risk after SVR achievement included advancing age, the presence of cirrhosis, and diabetes.2 It is striking, however, that 35% of HCC cases in that cohort arose within the first year after SVR attainment and the overall median time between SVR and HCC detection was 1.66 years.