Background: Direct Anti Hepatitis C Viral Agents (DAAs) were introduced for Hepatitis C Virus (HCV) infection management, which resulted in high sustained virological response (SVR) in many countries and a low failure rate. However, hepatocellular carcinoma (HCC) post DAAs therapy is controversial; few studies related aggressive pattern HCC to DAAs. Therefore, we aimed to study the hepatocellular carcinoma relation to direct anti-hepatitis C viral drugs. Patients and Methods: This observational case-control study included 67 adult Egyptian HCC patients associated with HCV diagnosed at the Zagazig University Hospitals, who were divided into two groups according to DAAs treatment. Results: HCC is more common in male patients (77.6%) of all studied cases, and those are treated by DAAs (62.7%). The median age of HCC post DAA was 63(48-83), while 58 (45-75) in HCC patients without DAA, with no significant difference p= 0.053. HCC presented in the non-DAAs treated group, mainly decompensating by hematemesis (HM) (32%). While in the post-DAAs group, HCC was significantly diagnosed mainly by abdominal pain at 31%. There is no significant difference as regards the liver status with frequent liver cirrhosis in both groups, 14(56%) and 32(76.2%). Liver cirrhosis (p-value 0.04) and advanced Child-Pugh classification (p-value 0.009) are predictors of DAAs-related HCC. Conclusion: DAAs therapy of HCV added no additional risk for hepatocellular carcinom