الفهرس 
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Abstract
Introduction : Direct acting antivirals (DAAs) is characterized by high rates of virological clearance. Regimens with various combinations of these new drugs, without the use of IFN, proved to be very effective and characterized by excellent tolerability and has dramatically improved HCV infection curability, especially for patients with advanced liver disease and for liver transplant recipients. Aim of this study: to evaluate the efficacy, safety and outcomes of direct acting antiviral drugs for treatment of HCV infection in patients with decompensated liver cirrhosis. Patients and methods: This prospective study conducted to 115 HCV decompensated cirrhotic patients accepted as candidates for direct acting antiviral drugs (DAAs) according to the National committee for control of Viral Hepatitis (NCCVH) treatment protocol under the supervision of Ministry of Health from July 2017 to September 2019. Methods: Patients were divided into group I: Will receive sofosbuvir and daclatasvir for 24 weeks. & group II: Will receive sofosbuvir, daclatasvir and ribavirin for 12 weeks and Control group III: Will not receive any treatment as they refuse antiviral therapy..All patients subjected to detailed history taking, full clinical examination including complete general examination and local examination for stigmata of chronic liver disease and hepatic decompensation.. All patient underwent the following: Laboratory investigations in the form of CBC, kidney and liver profiles, PT & INR, Fasting blood sugar & Hb A1C in diabetic patient, Alfa feto protein (AFP), quantitative PCR for HCV RNA, HBsAg. &Abdominal Ultrasound. (with full comment on liver, diameter of portal vein, spleen, presence of ascites, and kidneys size) & ECG (ECHO in patient > 65 y or cardiac patient) &Upper GI endoscopy before starting treatment and every 3 months as regular surveillance for diagnosis and management of esophageal and gastric varices and Child Pugh score & MELD score calculation. Results: Our study showed a statistically significant decrease of CTP and MELD scores in both group I and group II during follow at the end of treatment and 12 weeks post-treatment compared to baseline, while CTP score in control group showed a statistically significant increase during follow at the end of treatment and 12 weeks post-treatment compared to baseline, also mortality was significantly decreased in group I and group II compared to control group. This indicates that SVR achievement is associated with decreased mortality in patients with decompensated cirrhosis. By analyzing and processing the data obtained from the history and evaluation, our study declared that: Treatment of decompensated HCV cirrhotic patients with CTP score ≥7 (class B or C) by DAAs had led to SVR in about 91% of patients with improvement in CTP and MELD scores and a significant reduction in jaundice, variceal bleeding and hepatic encephalopathy with better control of ascites and improvement of synthetic liver functions. Addition of RBV and shortening the treatment period to 12 weeks proved to have the same outcome with no significant difference regarding SVR achievement and complications during treatment and follow up.