الفهرس 
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Abstract
Introduction and aim: Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring per year. WHO estimated that in 2019, approximately 290 000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer). The aim of this study is Determination of incidence of HCC post DAAs and also characterization of it as regard risk factors especially progression of fibrosis using noninvasive maneuvers. Patients and methods: This is a prospective observational cohort study including 218 consecutive chronic HCV patients with advanced liver fibrosis or cirrhosis receiving DAAs in the outpatient clinics at the Egyptian Liver Research Institute and Hospital (ELRIAH) from March 2018 until March 2021. Results: Our study showed that the cumulative incidence of HCC for all patients was 3.07/100 py in cirrhotic patients who achieved SVR following direct-acting antiviral treatment for hepatitis C genotype 4. Patients with HCC were significantly older (63.18 years vs. 56 years; P 0.004) with male predominance (54.5% in HCC patients versus 46.4 % in non-HCC patients; P .001). No significant difference was found between both groups as regard, AST, ALT, total bilirubin serum albumin, platelet count and AFP.There was no significant difference between HCC and non HCC paients groups in terms of comorbidities as diabetes mellitus, and hypertension t. Five out of the 11 HCC cases occurred during the first year of follow-up and 6 during the second year. Most of cases were discovered in a very early stage ( 8 cases were BCLC-0) .There is highly statistical significant difference in all patients as regard AST, ALT,AFP, platelet count and serum albumin and bilirubin between pretreatment VS one and two years assessment. There is highly statistical significant difference in all patients as regard liver stiffness measurements by fibrosscan , APRI, FIB-4 and FIB-6, between pretreatment VS one and two years assessmen. •Conclusion: The incidence of HCC significantly reduced during the first two year after end of DAAs treatment Older age is the most risk factor for developing HCC. There is marked improvement of liver functions and liver stiffnes and serum fibrosis biomarkers after DAAs. Keywords: HCC, DAAS, HCV,cirrhosis