الفهرس 
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Abstract
SUMMARY
Patients suffers from the morbidity and mortality of HCV with its resulting cirrhosis and hepatocellular carcinoma. The overall anti-HCV antibody prevalence of 14.7% and the number of Egyptians estimated to be chronically infected with HCV was 9.8%.
This study was conducted on 250 patients of relapsers in comparison with 250 patients of responders to determine factors that may
Associated with the relapse .
On comparison of host factors as age the group 20-30y patient of responders were 65 patients (26%) and in relapsers were 44 ptns (17.6%) of all patients , 30-40y patients responders were 90 (36%) and relapsers were 53 (21.1%) , 40-50y patients responders were 60 (24%) and relapsers were 66 (26.4%) of all patients,50-60y responders were 35by (14%) and relapsers were 87 (34.8%) .so old age was a significant predictor of relapse.
BMI was normal in 205 patients of repsonders (82%) and 125 patients of relapsers (50%) of all patients, overweight patients were 35 patients of responders (14%) and 89of relapsers (35.6%),obese patients were 10 of responders (4%) and relapsers were 36 (14.4%) of all patients.So increase BMI (over weight and obese) was a significant predictor of relapse.
Diabetic patients were 23 of responders (9.2%) and 41of relapsers (16.4%).So DM was more in relapsers group.
Positive anti schistosomal anti body patients were 41 of responders (16.4%) and 81of relapsers (32.4%).So schistosomiasis was a significant predictor of relapse.
Pre treatment viral load represented in comparison of two groups by moderate viral load patients were 163 of responders ( 65.2%) and 63 of relapsers (25.2%), high viral load patients were10 of responders (4%) and 165 of relapsers (66%) of all patients . So high viral load was a significant predictor of relapse.
Complete early virlogical response was more in responders than relapsers.
Partial early virlogical response was more in relapsers than responders
By comparison histopathological findings of two group by (METAVIR Score) in responder group, Necro inflammatory grades A1 was 85 patients (34%) , A2 was 123 patients (49.2% )and A3 was 42 patients (16.8%) this in comparison with relapsers group A1was 78 patients with (31.2%),A2 was 52 (20.8%) and A3 was 120 (48%.)So high steatosis level considered a significant predictor of relapse.
Stages of fibrosis F1 in responders was 85 patients by ratio 38% , F2 was 125 (44%), F3 was 38patients (16%) and F4was 2 ( 0.8%) of all patients. In relapsers 72 patients were in F1 stage (28.8%),65 patients were in F2 stage (26%) ,107ptns were in F3 (42.8%) and 6 patients were in F4 (2.4%).So high grades of fibrosis were associated by relapsers more than responders.
Cytopenias (anemia ,leucopenia and thrombocytopenia) showed highly significant ocurrance between relapsers than responders .
Mean values of ALT level were higher among relapsers than responders throughout the most of the period of the study.
Hyper bilirubinemia associated with relapsers than responders.
Side effects to treatment such as (flu like symptoms and depression)and non adherence to treatment were more associated with relapsers than responders.
CONCLUSION
1- There was a high relapse rate between patients (50-60y) age in comparison to other age groups.
2- Over weight and obesity contribute relapse to combined ttt.
3- There was considerable ratio of high viral load in pre treatment patients among relapsers.
4- Positive history of schistosomiasis is a significant predictor of relapse.
5- There was statistically significant relationship between level of steatosis with the occurance of relapse .
6- There was statistically significant ratio of haematological side effects anemia, leucopenia and thrombocytopenia throught out treatment associated with relapse.
7- There was significant ratio of occurance of flu like symptoms and depression among relapsers.
8- There was positive relationship between non adherence to treatment and the relapse of CHC patients.