TNF and neoplasm: This leads to chronic liver inflammation and fibrosis.160,297 The HCV NS5A protein is an activator of the NF-κB pathway, which encodes several cytokines, including IL-6, TNF-α, and IL-1β.298 Additionally, HCV-infected cells secrete TGF-β1 following ER stress and ROS generation, which activates hepatic stellate cells and promotes fibrosis.299 While TGF-β1 initially inhibits tumor formation, it later promotes proliferation, angiogenesis and EMT, accelerating tumor progression.