Effect of using Direct Acting Antivirals on the Synthetic Liver Functions in Treatment-Naïve Patients with Chronic Hepatitis C Virus Infection Genotype 4

Abstract

Abstract Background and aim of the study Interferon-free direct-acting antivirals (DAAs) combination therapies, including sofosbuvir (SOF), daclatasvir (DCV) and paritaprevir -r/ombitasvir therapy with or without ribavirin, eradicate chronic hepatitis C virus (HCV) in a high percentage of patients, but its impact on improvement of synthetic liver function is unclear. The aim of this study was to evaluate the effect of DAAs on the synthetic functions of the liver in treatment- naïve chronic HCV genotype 4 patients who treated by different regimens of DAAs for 12 weeks and achieved a sustained virological response at 12 weeks after treatment completion (SVR 12). Patients and Methods From September 2017 to March 2018, 150 treatment- naïve chronic HCV genotype 4 Egyptian patients received different DAAs regimens for 12 weeks were enrolled for this prospective cohort study, to evaluate the effect of DAAs on serum albumin, total bilirubin, INR, prothrombin concentration and platelets count at the end of treatment (WK12) and at week 12 post treatment in comparison to baseline. Patients were categorized to three groups; Group 1 (easy to treat) included 60 patients treated by SOF/DAC regimen, Group 2 (Difficult to treat) included 60 patients treated by SOF/DAC + ribavirin regimen and Group 3 included 30 chronic HCV patients with chronic kidney disease (eGFR ≤ 30 ml/min and Haemoglobin level >10g/dl) treated by Qurevo (paritaprevir-r/ombitasvir) + ribavirin and all included patients were treated for 12 weeks and achieved a sustained virological response at week 12 post treatment (SVR 12). Results 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. Conclusion In conclusion, based on analysis of all laboratory parameters in this study, we can conclude that direct acting antiviral therapy (DAAs) is effective in improvement of synthetic liver functions in chronic hepatitis C genotype 4 patients who achieved a sustained virological response.