Prevalence and PredictorsofHCV Relapse inEgyptian Patients After Direct Acting Antiviral Drugs

Abstract

Objectives : To assess the prevalence and factors that predict hepatitis C virus (HCV) relapse after direct-acting antiviral drugs. Background : Egypt is known to be one of the countries with a heavy burden of HCV infections. The introduction of direct-acting antivirals has represented a paradigm shift in HCV management. Patients and methods : The current study was a retrospective study done on 422 consecutive patients with HCV, who were selected from those attending the viral hepatitis C unit at Shebin El-Kom Teaching Hospital, Egypt from March 2019 to March 2020. All cases were subjected to thorough history taking, full clinical examination, and laboratory tests such as liver function pro fi les, renal function tests, complete blood count, serum alpha-fetoprotein, viral markers, and imaging data (abdominal ultrasonography and triphasic computed tomography). Results : Alanine aminotransferase, aspartate transferase, creatinine, fi brosis 4 (FIB-4), direct bilirubin, albumin, PCR, and international normalized ratio showed signi fi cant increases in nonresponders when compared with responders. Platelets showed signi fi cant increase in responders when compared with nonresponders. Treatment experience, high viral load, and appearance of liver cirrhosis (ultrasound) and FIB-4 were independent RF for relapse between the studied cases with odds ratio of 26.36 (6.4 e 108.6), 2.42 (1.16 e 9.03), 12.14 (3.0 e 49.16), and 2.01 (1.3 e 9.91), respectively. FIB-4 showed area under curve of 0.744 and at a cutoff point of 0.996had a sensitivity of 75%, speci fi city of 61%, positive predictive value of 10.2%, and negative predictive value of 98.2%. Regarding viral load, area under curve was 0.729, and at a cutoff point of 860 063.0, sensitivity was 70%, speci fi city 65.5%, positive predictive value 9.0%, and negative predictive value 97.7%. Conclusion : Simple basic investigations (complete blood count, liver function tests, renal function tests, and ultrasound) and case characteristics (age, sex, diabetes mellitus, hypertension, and smoking) are predictors of unrespon-siveness and selection of more potent regimens aiming at possible eradication.