Sofosbuvir-based treatment resulted in a clinically significant improvement in parameters of liver fibrosis.

BackgroundHepatic fibrosis is an inclusion indicator for treatment and a major independent predictor of treatment response in patients with chronic hepatitis C. Liver biopsy, considered as the “gold standard” for evaluating liver fibrosis, has carried some drawbacks. Currently used noninvasive predictors of fibrosis are considered less accurate than liver biopsy.ObjectivesOur aim was to assess noninvasive predictors of fibrosis in patients with chronic hepatitis C using the routine laboratory pre-treatment workup.Patients and MethodsCross sectional study including 4289 Egyptian patients with chronic hepatitis C were assessed for the need to interferon and ribavirin therapy. Routine pre-treatment workup and reference needle liver biopsy were performed. FIB-4 index, APRI and modified APRI scores were validated. Patients were divided into two groups, first with no or minimal fibrosis, and second with moderate and marked fibrosis using the Metavir score.ResultsMultivariate logistic regression analysis showed that age, body mass index, aspartate aminotransferase, alpha fetoprotein, platelets count, FIB-4 index, APRI and modified APRI score were significant independent predictors of fibrosis. Age > 43 years, aspartate aminotransferase > 47U/L, platelets < 205×103/mm3, and alpha fetoprotein > 2.6 ng/ml had the highest cutoff points in receiver operator characteristic curves. Taking into account the four variables together; the presence of ≥ 2 variables is associated with moderate and advanced fibrosis with a sensitivity of 0.81, specificity of 0.5, positive predictive value of 0.53 and negative predictive value of 0.79. FIB-4 index represented the best performing receiver operator characteristic curve for diagnosing moderate and marked fibrosis among other independent factors with a sensitivity of 0.74, specificity of 0.6, positive predictive value of 0.56 and negative predictive value of 0.76.ConclusionsChronic HCV pre-treatment routine work up and composite fibrosis scores are good noninvasive predictor of liver fibrosis and can be used as an alternative method to invasive liver biopsy without adding more financial expenses to the treatment.

Results of sofosbuvir-based therapies in Egypt achieved similar rates of SVR12 as seen in phase III efficacy studies.

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Sofosbuvir/Simeprevir combination is an effective and well tolerated regimen for patients with chronic HCV genotype IV.

BackgroundEgypt has one of the highest (16-8%) prevalence rates of HCV infection in the world. Approximately 90% of Egyptian HCV isolates belong to a single subtype (4a), which responds less successfully to interferon therapy than other subtypes. Studies comparing the efficacy and safety of PEGIFN alfa-2a and PEGIFN alfa-2b in treatment-naive HCV-infected patients have shown conflicting results.ObjectivesAssessing the effects of Peginterferon alpha-2a versus Peginterferon alpha-2b on the sustained virological response in naive chronic HCV genotype-4 Egyptian patients.Patients and MethodsThis retrospective study cohort consists of 3718 chronic HCV patients admitted to a large, Egyptian medical center. 1985 patients had been treated with PEG-IFN alfa-2a plus RBV and 1733 patients with PEG-IFN alfa-2b plus RBV between years 2007-2011. Efficacy outcomes were sustained virologic response (SVR) and treatment discontinuation rates due to serious adverse effects.ResultsThe ETR & SVR in patients treated with PEGIFN alfa-2a was 64.1% and 59.6% as compared to treatment with PEGIFN alfa-2b where these parameters were 58.2% and 53.9% respectively (P < 0.05). Treatment discontinuation rates, were similar in the two types of PEGIFN [0.66 (0.37-1.16); P = 0.15]. Significant dose reduction was evident with peginterferon alfa-2b (35.3%) than peginterferon alpha-2a (27.3 %) (P < 0.01). Patients with lower base line AFP and ALT were most likely to achieve SVR using INF alpha 2-a.ConclusionsPeginterferon alpha-2a has a higher efficacy regarding ETR and SVR as compared to Peginterferon alfa-2b in treatment of naive chronic HCV genotype-4 patients.