Background The benefits of treatment of hepatitis C virus with direct-acting antiviral drugs in patients with decompensated liver cirrhosis (DLC) are still unclear. Aim To evaluate the degree of improvement in hepatic decompensation events and quality of life (QOL) in treated patients with DLC. Patients and methods One hundred and fifty patients with hepatitis C virus-related DLC were included; 75 of these patients received treatment (group I) [sofosbuvir (SOF) with either daclatasvir or ledipasvir for 24 weeks without ribavirin (RBV) or for 12 weeks with RBV] and 75 patients did not receive treatment as a comparable group (group II). Patients who achieved a sustained virological response at 12 weeks were assessed in terms of decompensation events, model for end-stage liver disease score, Child–Turcotte–Pugh score, biochemical changes, and QOL (applied on Mcguill QOL questionnaire) before starting treatment and 6 months after end of treatment, and were compared with untreated patients. Results Forty-two (56%) patients received SOF/daclatasvir for 24 weeks without RBV and 19 (25.3%) patients received SOF/ledipasvir for 24 weeks without RBV. The model for end-stage liver disease score improved in treated patients (mean change –1.73), but worsened in untreated patients (mean change +11.8) before and after 6 months. Also, the Child–Turcotte–Pugh score improved significantly (P<0.001). Serum albumin, prothrombin time, bilirubin, α-fetoprotein, and alanine aminotransferase improved in treated patients (P<0.001). Health-related QOL improved in treated patients (mean change +17.65) and worsened in untreated ones (mean change −18.68; P<0.001). Conclusion Treated patients with DLC showed an improvement in liver tests and health-related QOL. Longer durations of follow-up for decompensation events are needed.

Only a few treatments are approved for coronavirus disease‐2019 (COVID‐19) infections, with continuous debate about their clinical impact. Repurposing antiviral treatments might prove the fastest way to identify effective therapy. This trial aimed to evaluate the efficacy and safety of sofosbuvir (SOF) plus daclatasvir (DCV) or ravidasvir (RDV) added to standard care (SOC) for patients with moderate and severe COVID‐19 infection. Multicentre parallel randomized controlled open‐label trial. One hundred and twenty eligible patients with moderate and severe COVID‐19 infection were randomized to one of the study arms. Ten days of treatment with SOF plus DCV or RDV in addition to the standard of care compared to SOC. Follow up in 7 days. Sum of the counted symptoms at 7 and 10 days, mean change in oxygen saturation level, viral negativity, and rate of intensive care unit (ICU) admission. Compared to SOC, the SOF‐DCV group experienced a significantly lower sum of the counted symptoms (fever, headache, generalized aches, or respiratory distress) combined with no evidence of deterioration (ICU admission and mechanical ventilation) on Days 7 and 10 of treatment. Oxygen saturation also significantly improved among the SOF‐DCV group compared to SOC starting from Day 4. The study also showed positive trends regarding the efficacy of SOF‐DCV with a lower incidence of mortality. On the other hand, adding SOF‐RDV to SOC did not show significant improvements in endpoints. The results support the efficacy and safety of SOF‐DCV as an add‐on to SOC for the treatment of moderate to severe COVID‐19 infections.

Background and Aim Existing data are controversial regarding the incidence of hepatitis C (HCV)–related hepatocellular carcinoma (HCC) following directly acting antiviral (DAA) therapy. This prospective study aimed to assess incidence, and risk factorss of HCC following DAA therapy in patients with HCV-related advanced fibrosis (F3) and cirrhosis (F4). Methods Incidence of HCC was calculated in 1,630 patients with HCV-related F3 and F4 treated with DAA prospectively followed for up to 43 months in a single tertiary referral center and compared to historical controls. Risk factors of incident HCC were also determined. Results The crude outcome rate was 2.15/100 person-years, significantly lower than a similar historical cohort (5.57/100 person-years). Risk of developing HCC was higher with the presence of cirrhosis (F4 vs F3, AHR 3.59) and treatment failure (vs achieving SVR, AHR 3.37). Presence of decompensated cirrhosis, platelet count <100×10 3 /mL, and high AFP were independent risk factors of developing HCC. Conclusion Incidence of HCC was significantly lower in patients with HCV-related advanced fibrosis and cirrhosis treated with DAAs than in a historical cohort of untreated patients. Decompensated cirrhosis, baseline AFP ≥10 ng/mL, diabetes, and nonresponse to DAA were independent risk factors of incident HCC.

Background and aimHepatitis C virus is a leading cause of chronic liver disease. Elevated serum a-fetoprotein (AFP) has been used as a marker for hepatic regeneration after the destruction of hepatocyte in viral hepatitis. Recently, c-glutamyl transpeptidase (GGT) has also been taken into account in the evaluation of patients with chronic hepatitis C (CHC). This study aimed to examine the association between serum AFP and serum GGT levels, and treatment outcome in patients with CHC treated with pegylated interferon and ribavirin. Patients and methodsWe examined the association between AFP and GGT levels and sustained virological response (SVR) in 150 patients with CHC in whom antiviral therapy was initiated. Serum AFP, GGT, and hepatitis C virus RNA were tested for patients completing 48 weeks of treatment and patients who responded to treatment after 6 months. Results AFP and GGT levels were lesser in patients who achieved SVR than in those who did not achieve a response. The logistic regression model (univariate analysis) of factors associated with SVR showed a significant increase in SVR when AFP ranged from 2.8 to 9.9 ng/ml, GGT less than or equal to 50 U/l, and Ishak fibrosis score less than or equal to F2. Serum AFP and GGT were strongly correlated in multivariate analysis; only GGT less than or equal to 50 U/l and AFP from 2.8 to 9.9 ng/ml were independent predictors of SVR, whereas Ishak score of fibrosis was a dependent predictor for SVR. Conclusion AFP and GGT can be used as independent predictors of treatment response in patients with CHC receiving pegylated interferon and ribavirin.