Noninvasive biomarkers predict improvement in liver fibrosis after successful generic DAAs based therapy of chronic hepatitis C in Egypt

Background: The scale of HCV problem in Egypt prioritized the development of a national control strategy that employs the use of locally manufactured generic direct-acting antivirals (DAAs). Achieving sustained virologic response in chronic HCV patients is the key for preventing fibrosis progression and ultimately its resolution.Objective(s): To evaluate impact of generic DAAs on liver fibrosis in chronic HCV patients using some noninvasive biomarkers (NIBMs).Methods: A total of 280 chronic HCV patients (18 treatment experienced and 262 naive) were enrolled and received the standard of care. All patients were clinically evaluated before starting treatment and at 4, 12 and 24 weeks of treatment.Results: The sensitivity and the specificity of the tested NIBMs for predicting cirrhosis versus liver ultrasound ranged between 75.0-79.6% and 59.4-67.2% respectively. All NIBMs showed significant linear decline during the treatment and follow up periods among responders but tended to fluctuate in values toward an increase among non-responders. In cox regression analysis, normal baseline ALT, AST, total serum cholesterol, serum albumin, WBCS, prothrombin activity and early stages of liver fibrosis predicted improvement in liver fibrosis by 1.5-2 folds. The mean probability of recovery at 1, 3, 6 months varied between the different scores and ranged from 0.059 to 0.637, 0.125-0.741, 0.538-0.951 respectively.Conclusion: The results provide prognostic data on the improvement in liver fibrosis over the treatment course and follow up periods without the need for a liver biopsy. Early detection and management of HCV infection should be emphasized to maximize the benefits of the treatment.