الفهرس 
Introduction
Hepatitis C virus (HCV)Only 14 pages are availabe for public view
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Abstract
Hepatitis C virus (HCV) is a significant public health problem and the leading cause of hepatocellular carcinoma. Direct-acting antiviral agents (DAAs) represent a revolution in HCV treatment with high rate of sustained virological response (SVR). Data on chronic HCV related HCC recurrence in patients whose HCC was previously ablated completely, and treated by direct-acting antivirals (DAAs). The aim of this work is To study the impact of DAAs on HCC recurrence in chronic HCV infected cirrhotic patients with previously ablated HCC, and discuss the most probably theories of recurrence. We enrolled 39 patients after at least 3 months of complete ablation of HCC, subsequently treated with DAAs and followed for 6 months after end of treatment. Laboratory, radiological and virological data were collected for statistical analysis. About (87.2%) of all patients achieved sustained virological response. HCC recurrence were observed in twelve patients (30.8%).The patients with HCC recurrence were significantly higher in FIB-4, AFP, INR and serum bilirubin before start of treatment. It is observed that Child-Pugh Class B, more severe liver fibrosis and lower platelet count were significantly associated with HCC development. There is no clear evidence that the drugs themselves cause HCC recurrence or increase the risk of HCC recurrence following DAAs However, there are many possibilities that can explain the recurrence included presence of microvascular invasions not predicted with imaging studies, the fragile equilibrium between a pro tumor and anti-tumor function of the immune system, the rapid decrease of NKG2D at the end of the therapy and the low level of immunosurveillance in patients with advanced fibrosis may hence accelerating HCC growth. Lastly we can’t ignore that the inflammation has a protective effect preventing HCC recurrence. So strict follow up after end of therapy till at least 6 months is highly recommended as the risk of HCC recurrence still high even achieved the SVR.