Abstract
Background: Hepatitis C is a worldwide problem with a prevalence estimated to be 3 % according to the World Health Organization (WHO) about 130-150 million people worldwide are chronically infected with hepatitis C virus (HCV). Egypt has the highest prevalence of HCV estimated to be 7.3% with predominance of genotype 4. Direct -acting antiviral agents (DAAs) are highly effective and well tolerated in patients with chronic hepatitis C virus infection, including those with compensated cirrhosis. The availability of antiviral agents, which can be administered in short, interferon (IFN)‐free regimens, has improved the management of patients with HCV infection dramatically. Clinical studies have demonstrated rates of sustained virologic response (SVR) of over 90% with these regimens, even in patients with compensated cirrhosis. Aim: The aim was to assess the clinical impact of direct-acting antiviral treatment in patients with compensated hepatitis C virus-related cirrhosis after one year of follow-up. Methods: An observational prospective study was conducted on 100 patients with compensated cirrhosis treated in 2017, analyzing the evolution of liver function and the development of hepatocellular carcinoma and clinical decompensation. Results: Most patients were males (60%), the mean age was 57.3±6.1years. All participants were Child-Pugh A class at the start of the treatment. SVR 12 was achieved in all patients (100%). Eight patients suffered clinical decompensation, three( 3.3%) of them changed to Child B and five (5.5%) patients changed to Child C. The incidence of de novo hepatocellular carcinoma during the follow-up was (4 %). There was a significant improvement in the mean platelets count, AST, ALT (P < 0.001) after treatment and the mean albumin level decreased but still in the normal range. Conclusion: Treatment with Direct-acting antiviral was assosciated with high rates of SVR, but not associated in the short term with a decrease in the development of hepatic decompensation or hepatocellular carcinoma compared to what it was reported for untreated compensated cirrhotic patients.
Highlights
Hepatitis C is a worldwide problem with a prevalence estimated to be 3 % according to the World Health Organization (WHO) about 130-150 million people worldwide are chronically infected with hepatitis C virus (HCV)
Sequelae of chronic HCV may lead to liver cirrhosis in nearly 20-50 % of patients infected; this may be complicated by liver cell failure and hepatocellular carcinoma later on and can occur relatively rapidly
Clinical studies have demonstrated rates of sustained virologic response (SVR) of over 90% with these regimens, even in patients with compensated cirrhosis (4)
Summary
Hepatitis C is a worldwide problem with a prevalence estimated to be 3 % according to the World Health Organization (WHO) about 130-150 million people worldwide are chronically infected with hepatitis C virus (HCV). Direct -acting antiviral agents (DAAs) are highly effective and well tolerated in patients with chronic hepatitis C virus infection, including those with compensated cirrhosis. The availability of potent, well‐tolerated direct‐acting antiviral agents (DAAs), which can be administered in short, interferon (IFN)‐free regimens, has improved the management of patients with HCV infection dramatically. Clinical studies have demonstrated rates of sustained virologic response (SVR) of over 90% with these regimens, even in patients with compensated cirrhosis (4). Lower virologic response rates have been reported in patients with advanced liver disease and decompensated cirrhosis.(5). Achievement of SVR with IFN‐free regimens in patients with cirrhosis decreases hepatic decompensation, HCC, and liver‐related mortality
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