It can make an impact on the different stages of cancer development (Jomova and Valko, 2011). It can alter the DNA sequence in the initiation step, increase cell division/ reduce apoptosis in the promotion stage and can also promote additional changes to the DNA in the progression

Background Hepatitis C virus infection is a global health challenge with Egypt being one of the highly affected countries. IL-10 has been suggested as a suitable marker to assess necroinflammation and to monitor the progression of liver damage. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor playing a central role in many physiological as well as pathological processes. Several factors can be predictive of the response to treatment and achievement of SVR; some of which are host-related, and others are virus-related. The gene expression of IL-10 and VEGF have multiple effects for treatment response. The aim of the present work was to study the effect of treatment with directly acting agents (DAA) on the expression of VEGF and IL-10 genes in chronic hepatitis C virus-infected Egyptian genotype-4a patients. Twenty-five HCV subjects where evaluated for IL-10 and VEGF gene expression before and after treatment with DAA. Results IL-10 expression was downregulated in 92% of the cases. VEGF expression was heterogeneous showing spreading of values along a wide range with 64% of the cases being downregulated. Conclusion DAAs do not completely reverse the immunological imprints established upon chronic HCV infection.

The hepatitis-C virus (HCV) prevalence in the age group (15-59 years) has declined from 14.7% in 2008 to 10.6% in 2015 (Waked et al., 2020). However, the disease burden and complications such as cirrhosis, the most important risk factor in developing liver cancer, continues to grow considerably due to the increased survival rate of cirrhotic patients (Rashed et al., 2020).The Barcelona Clinic Liver cancer (BCLC) system is currently the only staging system that includes an