- ABSTRACT.
- INTRODUCTION
- METHODS
- RESULTS
- Characteristics of the study population.
- Clinical evaluation of the study cohort.
- Biochemical and hematological changes over the course of treatment and follow-up.
- Outcomes of liver disease at different time points.
- Predictors of adverse liver events in patients who achieved SVR.
- The probability of developing complications in patients with HCV who achieved SVR.
- DISCUSSION
- STUDY LIMITATIONS
- ACKNOWLEDGMENTS
- REFERENCES
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Liver Disease Outcomes after Sustained Virological Response in Patients with Chronic Hepatitis C Infection Treated with Generic Direct-Acting Antivirals
Ekram W. Abd El-Wahab
Ekram W. Abd El-Wahab
Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt;
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Waleed M. Abd Elgawad
Waleed M. Abd Elgawad
Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt;
Department of Endemic and Infectious Diseases, Damanhour Fever Hospital, Ministry of Health and Population, Damanhour, Egypt;
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Department of Endemic and Infectious Diseases, Damanhour Fever Hospital, Ministry of Health and Population, Damanhour, Egypt;
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Mohamed Said
Mohamed Said
Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ashraf I. Mikheal
Ashraf I. Mikheal
Department of Endemic and Infectious Diseases, Damanhour Fever Hospital, Ministry of Health and Population, Damanhour, Egypt;
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Hanan Z. Shatat
Hanan Z. Shatat
Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt;
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ABSTRACT.
The introduction of generic direct-acting antivirals (DAAs) in Egypt is associated with a superior cure rate of hepatitis C virus (HCV) infection. However, the course of progressive liver damage and developing liver related complications in patients with sustained virologic response (SVR) remain unclear. This study was designed to examine the long-term outcomes of generic DAA-induced virological cure in a real-life cohort of HCV patients with or without comorbid schistosomiasis. We prospectively enrolled a cohort of 506 recently cured HCV patients (437 Child–Pugh class A [Child-A] and 69 Child–Pugh class B [Child-B]). All patients were clinically evaluated at different time points during a 2-year follow-up (November 2018 to February 2021). Over the course of treatment and follow-up, 77 (15.2%) patients (42 [9.6%] Child-A and 35 [50.7%] Child-B) experienced complications at different time points. The overall mortality rate was approximately 1/1,000 person-years. The incidence of hepatic insufficiency was approximately 5.5/1,000 person-years, and that of de novo hepatocellular carcinoma (HCC) was approximately 8.3/1,000 person-years. A sustained improvement in liver indices up to 2 years of follow-up was observed. In the Cox regression model, pretreatment decompensated cirrhosis predicted the occurrence of adverse liver events and HCC after therapy. In conclusion, in HCV patients with advanced cirrhosis or coexisting hepatic schistosomiasis, generic DAA-induced SVR remains robust with favorable clinical outcomes although the risk of hepatocarcinogenesis cannot be eliminated. Surveillance of patients with treated HCV infection is an important aspect of postcure care for early detection and management of liver disease-related adverse events.
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Author Notes
Disclaimer: The study was approved by the institutional review board and the Ethics Committee of the High Institute of Public Health-Alexandria University [no. 1038-2019]. The research was conducted in accordance with the ethical guidelines of Helsinki’s Declaration (2013). Informed written consent was obtained from each participant after explaining the aim and concerns of the study Data sheets were coded with numbers to maintain the anonymity and confidentiality of patient’s data. This article does not contain any studies with animals performed by any of the authors. All data are fully available without restriction by the corresponding author at ekram.wassim@alexu.edu.eg.
Authors’ addresses: Ekram W. Abd El-Wahab and Hanan Z. Shatat, Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt, E-mails: ekram.wassim@alexu.edu.eg and hiph.hshatat@alexu.edu.eg. Waleed M. Abd Elgawad, Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt, and Department of Endemic and Infectious Diseases, Damanhour Fever Hospital, Ministry of Health and Population, Damanhour, Egypt, E-mail: hiph.waleedabdelgawed@alexu.edu.eg. Mohamed Said, Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt, E-mail: msabdelaziz76@kasralainy.edu.eg. Ashraf I. Mikheal, Department of Endemic and Infectious Diseases, Damanhour Fever Hospital, Ministry of Health and Population, Damanhour, Egypt, E-mail: mekhaelashraf@yahoo.com.
- ABSTRACT.
- INTRODUCTION
- METHODS
- RESULTS
- Characteristics of the study population.
- Clinical evaluation of the study cohort.
- Biochemical and hematological changes over the course of treatment and follow-up.
- Outcomes of liver disease at different time points.
- Predictors of adverse liver events in patients who achieved SVR.
- The probability of developing complications in patients with HCV who achieved SVR.
- DISCUSSION
- STUDY LIMITATIONS
- ACKNOWLEDGMENTS
- REFERENCES
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