الفهرس 
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Abstract
Hepatitis C virus (HCV) is a worldwide etiology of chronic hepatic insult particularly in Egypt where the main genotype is genotype 4 which is responsible for 90% of infections and the remaining is due to genotype-1. Unfortunately, most of patients are unaware by their illness and many cases are discovered lately after occurrence of substantial liver fibrosis.
The World Health Organization estimate that hepatitis C virus (HCV) infects 58 million people globally and causes approximately 399,000 deaths annually due to the complications of progressive liver fibrosis, including decompensated cirrhosis and HCC. By blood borne transmission, there were 1.5 million new HCV infections worldwide per year, that is 23.7 per 100,000 people.
In recent years, the treatment of HCV has been evolved with the development of direct acting antiviral (DAAs) therapies, and they have entered the clinical practice in 2014/2015. They showed a promising future for HCV treatment with higher SVR rates, shortened and simplified regimens, and minimal treatment-related side effects in HCV patients.
Measurement of hepatic fibrosis noninvasively enables the identification of at-high risk patient without the need for liver biopsy. The application of the noninvasive techniques produced a simplified approach in the management of patients with chronic HCV infection. The achievement of sustained virologic response (SVR) after treatment had been evidenced to have a reduced risk of hepatocellular carcinoma (HCC) and liver cell failure. This is probably attributed to the fibrosis regression after viral eradication.
Summary
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Unfortunately, patients who have advanced fibrosis or cirrhosis remain at a higher risk of complications even after SVR achievements. Associated comorbidities, such as metabolic syndrome, alcoholic or nonalcoholic steatohepatitis may also contribute to such liver-related complications.
In this era of highly effective DAA agents leading to enormous cure rates, identifying and monitoring patients who remain at a high complication risk after achieving SVR continue to be a critical issue.
Several validated methods for noninvasive measurement of liver fibrosis can be used in the management of HCV infection. Liver stiffness measurement using Fibro Scan is a novel rapid and non-invasive technique that evaluates liver fibrosis. In some cases, however, no elasticity measurement is obtained.
The study is aimed to evaluate the changes in liver stiffness measurement using fibroscan in patients with chronic hepatitis C virus treated with direct acting antiviral therapy.
This is a prospective observational cohort, was conducted on 140 patients with chronic HCV diagnosed by HCV Ab+ve by immunoassay and quantitative PCR.
The main results of the study revealed that:
Regarding liver functions tests, it was noticed that ALT and AST were significantly decreased after achieving SVR 24 weeks compared to before treatment while albumin was significantly increased after achieving SVR 24 weeks compared to before treatment. On the other hand, there was no statistically significant difference in total bilirubin, PC, INR and AFP before and after treatment.
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Regarding CBC, platelets level was significantly increased after achieving SVR 24 weeks compared to before treatment. On the other hand, there was no statistically significant difference in HB and WBCs at entry of the study compared to end of the study.
Liver stiffness measured by fibroscan was significantly lower after achieving SVR 24 weeks compared to before treatment. Fib 4 score and APRI-score showed significant decrease after achieving SVR 24 weeks compared to before treatment.
Liver stiffness can distinguish F0-2 non-advanced fibrosis from F3-4 Advanced fibrosis at cut off 8.0 with sensitivity, specificity, PPV and NPV was 79.5%, 90%, 88.57% and 80% respectively. APRI-score can distinguish F0-2 non-advanced fibrosis from F3-4 Advanced fibrosis at cut off 0.314 with sensitivity, specificity, PPV and NPV was 71.4%, 44.5%, 43.48% and 71.43% respectively. Fib4 calculation can distinguish F0-2 non-advanced fibrosis from F3-4 Advanced fibrosis at cut off 1.18 with sensitivity, specificity, PPV and NPV was 78.6%, 64.1%, 63.04% and 78.57% respectively.