الفهرس 
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Abstract
This study was conducted in the virology clinic of Minia university hospital and hepatology center, during the period from September 2018 to October 2019 aiming to determine the effect of treatment with Direct Acting Antivirals (DAAs) on liver fibrosis changes in chronic hepatitis C patients.
This study included 50 patients with chronic hepatitis C who were eligible for treatment with direct acting antiviral drugs.
This group of patients included 26 females and 24 males; their ages range from 24 to 73 years. All of them had been received sofosbuvir / Daclatasvir with or without Ribavirin for 12 weeks duration. All patients were observed from the start of treatment till 24 weeks after the end of therapy.
Sustained virological response (SVR) was achieved in 94 % of patients at 24 weeks after the end of treatment. All lab investigations were done at the start of therapy and 24 weeks after the end of treatment.
Exclusion criteria:
Any patient with any of the following:
1-HBV or HIV co-infection.
2-Inadequately controlled diabetes mellitus (HbA1c >9%).
3-Decompensated liver cirrhosis (Child Pugh B and C) or ascites.
4-HCC
5-Extrahepatic malignancy
6-Renal impairment (Serum creatinine > 2.5 mg/dl)
7-Pregnancy
All patients were subjected to:
(1)-Full history taking.
(2)- Thorough Clinical Examination was done at the start and at each visit for follow up.
(3)- Laboratory investigations:
• Liver function tests.
• Renal function tests.
• Complete blood count (C.B.C).
• Random blood sugar.
• Real time PCR for HCV RNA.
• Hepatitis B surface antigen & HIV antibody.
• Serum Alpha-fetoprotein (AFP).
• Serum cholesterol level.
• Serum marker: tissue inhibitor of metalloproteinases-1 (TIMP-1).
3-Radiological investigations:
• Abdominal ultrasound.
• Shear wave elastography (SWE).
Statistical Methodology:
All statistical analyses were implemented using SPSS software version 22 and GraphPad Prism version 5.0 (GraphPad Software, San Diego, CA, USA) for Windows.
The Results revealed that:
By comparing the all parameters of the studied patients at the start of treatment and 24 weeks after treatment we found that:
1. There was a reduction in AST and ALT levels which may reflect improvement of necroinflammation and there was increase in platelet count which was expected due to HCV eradication and significant improvement in liver fibrosis.
2. The serum cholesterol levels increased significantly after treatment.
3. Regarding serum TIMP-1 we found that there was a significant decline in its level after treatment.
4. Regarding fibrosis scores we found that there was a significant improvement in liver fibrosis stages as evidenced by fibrosis-4 (FIB4) and Forns scores after treatment.
5. By assessing liver stiffness, we found that there was a significant improvement of liver stiffness measurements by shear wave elastography.
Conclusion:
Chronic hepatitis C is a global health problem associated with significant degree of morbidity and mortality, that result mainly from fibrosis progression towards cirrhosis and HCC.
The new DAAs have revolutionized the treatment of CHC and obtained a higher SVR.
In our study we tried to evaluate liver fibrosis changes and the effect of DAAs on it. We used noninvasive methods; biomarker-based fibrosis panels confirmed with liver stiffness measurements by SWE. These methods facilitated the staging of liver fibrosis and frequent long-term monitoring.
We found that there is improvement in liver function after HCV treatment which may reflect improvement of necroinflammation by antiviral therapy.
Data from our study revealed that HCV treatment with DAAs causes a clinically significant regression in hepatic fibrosis, evidenced by improvement in several biomarker-based fibrosis panels, including TIMP-1, FIB-4 and Forns scores and improvement of liver stiffness measurements by SWE.
Recommendations:
1. Patients with HCV infection should receive treatment without delay if they were candidate for therapy.
2. Close and careful monitoring of patients during treatment.
3. After completion of therapy, regular follow up is mandatory for monitoring impact of SVR on dynamics of liver fibrosis and regression.
4. A larger study should be done with a large sample size to confirm our result with long duration of follow up.