الفهرس 
? Chronic Hepatitis C InfectionOnly 14 pages are availabe for public view
Abstract
T
here are approximately 71 million chronically infected individuals worldwide, many of whom are unaware of their infection, with important variations according to the geographical area. It is a leading cause of liver related morbidity and mortality through its predisposition to liver fibrosis, cirrhosis, and liver cancer.
The standard of care until 2011 was a combination of pegylated interferon-alpha (PEG-IFN), administered subcutaneously and ribavirin (RBV) taken orally. This combination could lead to a sustained virological response (SVR) and, based on long-term follow up results, However, such treatment is associated with significant adverse events and furthermore, poorly tolerated and less efficacious in subjects with advanced disease who are at most need.
The introduction of direct acting antiviral drugs (DAAs), with two protease inhibitor drugs licensed in 2011, has improved treatment responses rates and heralded a new era of HCV treatment. A pipeline of new DAAs are in various stages of pre-clinical and clinical development creating great optimism for the future of managing chronic HCV infection with simple, short, interferon-free, all oral regimens.
The aim of present study is to evaluate the effect of direct acting antivirals (DAAs) on the synthetic functions of the liver in the treatment-naïve Egyptian patients with chronic hepatitis C genotype 4.
This cohort study was conducted on one hundred and fifty (150) Egyptian patients with chronic HCV, randomly selected from those who attended Ain Shams University Hospital and the Medical Research Center of Ain Shams University which is one of the main centers of the National Committee for Control of Viral Hepatitis (NCCVH) and were treated by different regimens of DAAs. All of them were treatment naïve patients, treated for 12 weeks and achieved SVR 12 at week 12 post treatment. Serum albumin, total bilirubin, PC, INR and platelets count were investigated at the onset of the treatment (Week 0) and at different time points during treatment (weeks 4 & 8), at the end of treatment (week 12) and at week 12 post treatment.
Patients were subdivided into three groups; (group 1) which included sixty patients who are termed “easy to treat patients” treated by sofosbuvir 400mg + Daclatasvir 60 mg once daily for 12 weeks and achieved SVR 12 at week 12 post -treatment, (group 2) included sixty patients who are termed “difficult to treat patients” treated by Sofosbuvir 400 mg + Daclatasvir 60 mg + a weight based dose of ribavirin once daily for 12 weeks and achieved SVR 12.
group 3 included thirty chronic kidney disease patients with GFR below 30 ml/min infected with chronic hepatitis C genotype 4 infection treated by Qurevo (ombitasvir/ paritaprevir/ ritonavir) plus ribavirin for 12 weeks and achieved SVR 12.
There was a statistically highly significant improvement of serum albumin, total bilirubin, PC and INR (P = 0.001) among groups 1 and 2 patients at both time points _the end of treatment and WK12 post treatment_ (except for s. total bilirubin; P value was 0.11 at the end of treatment as compared to baseline). Platelets count showed a statistically highly significant improvement (P = 0.001) at both time points among group 1 patients, however among groups 2 and 3, it showed a statistically highly significant decline at the end of treatment (P = 0.001) as compared to baseline then showed a statistically highly significant improvement at WK12 post treatment (P = 0.001) among group 2 patients and (P = 0.027) among group 3 patients as compared to baseline value. Among group 3 cases there was a statistically significant improvement of serum albumin (P = 0.001) and PC (P = 0.025) at WK12 post treatment as compared to baseline.
This study concluded that DAAs improve synthetic liver functions in chronic hepatitis C patients who achieved Sustained virological response (SVR).