الفهرس 
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Abstract
Our aims were: Firstly; to assess the rate of SVR in patients treated with sofosubvir-based regimens. Secondly; to study the biochemical response to therapy in the studied patients. Lastly; to evaluate early changes of hepatic fibrosis using liver stiffness measurement, APRI, FIB4, and other serum fibrosis markers during sofosbuvir-based antiviral therapy.
A prospective study was conducted in which patients were recruited from Tropical Medicine and Gastroenterology outpatient clinic, Sohag University Hospital and Sohag Centre for Cardiac and Digestive Diseases during the period from July 2016 to January 2018. One hundred thirty -five patients (90 males and 45 females) eligible for treatment with sofosbuvir-based regimens were included in the study. Their ages ranged between (21 – 70 years). Their mean age was 49.84±11.98.
All patients were treated with sofosbuvir-based regimens for 12 weeks. Sixty-eight patients received dual therapy (sofosbuvir (SOF) (400 mg once daily) and daclatasvir (DCV) (60 mg once daily)) and sixty- seven patients received triple therapy (SOF(400 mg once daily) and DCV (60 mg once daily) with RBV(weight-based up to 1000 mg/day)).
The study protocol was approved by the Ethics Committee of Sohag Faculty of Medicine. After signing an informed written consent, all patients underwent a complete medical history, clinical examination, laboratory investigation, abdominal ultrasonography and SWE examination. Patients were followed up by complete blood count & liver function tests at baseline, treatment week 4, end of treatment and 12 weeks after completing treatment. SWE examination was done at baseline and at 12 weeks after completing treatment.
We found that all patients who received treatment had an undetectable level of viremia at the end of treatment with 98.52% of them achieving SVR12. Fatigue and headache were the most common adverse events of sofosbuvir -based treatment in studied patients. Also, there was a significant improvement in liver function parameters (ALT, AST, albumin and coagulation profile) at SVR12. We also noticed that the LSM, the level of FIB4, APRI, AAR, King score and GUCI were significantly reduced after SVR12. Also, There was a significant reduction of LSM, king score, APRI, AP index and GUCI values in advanced fibrosis and cirrhosis (F3, 4) compared to mild to moderate stage of fibrosis (F0, 1, 2).
In conclusion, sofosbuvir plus daclatasvir with or without ribavirin were highly effective and well tolerated. After SVR12, there was improvement in liver function parameters and reduction in hepatic fibrosis as proven by improvement in LSM and serum fibrosis scores.
Recommendation
• Further studies on Child B and Child C patients are needed to provide a more complete picture of the effectiveness of SOF/DCV therapy.
• Further prospective long term follow up studies are required to evaluate further changes in liver stiffness after SVR12. Pre-treatment liver stiffness measurements may be useful for predicting the response to treatment with DAAs.