Background It is estimated that approximately 10 million individuals in Pakistan are infected with hepatitis C virus (HCV). Historically, it was very difficult not just to cure but even treat HCV as available options did not have desirable outcomes. However, the approval of directly acting antiviral (DAA) drugs has revolutionized treatment and management. These are specific proteases and polymerase inhibitors with profound capability for accomplishing elimination and overtime eradication of the virus. Objective The aim of this study was to evaluate the efficacy and safety of sofosbuvir (SOF) in combination with ribavirin (RIB) for the treatment of chronic hepatitis C virus with genotype 3. Materials and methods This prospective observational study was conducted at the gastroenterology section of Medical Unit IV, Jinnah Post-graduate Medical Center, Karachi and Medical Unit II, Dow University of Health Sciences, Ojha Campus, Karachi from January 2016 to December 2016. Patients aged 18 years or older of either gender having chronic active HCV infection as demonstrated by a positive Anti-HCV (ELISA) test and a qualitative polymerase chain reaction (PCR) analysis along with genotype analysis showing only type 3 were inducted into the study. Treatment was initiated with either 12-week or 24-week regimen of SOF 400 mg once daily along with weight-adjusted RIB orally. Successful treatment was indicated by the elimination of the virus, i.e., undetectable viral load/levels by PCR qualitative analysis. Rapid virological response (RVR), end of treatment response (ETR), and sustained virological response (SVR) were defined as the undetectable viral load at four, 12, and 24 weeks, respectively. Results A total of 300 patients were inducted into the study, predominantly female (57%). The mean age of presentation was 41.14 ± 11.48, and most (70.33%) were treatment naïve. The mean alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) levels at presentation were 41.89 ± 46.23 IU/l, 68.57 ± 83.62 IU/l, and 54.52 ± 77.57 IU/l, respectively. ALT, AST, and GGT levels at 24 weeks were 33.84 ± 13.60 IU/l, 32.44 ± 16.16 IU/l, and 37.59 ± 22.41 IU/l, respectively, showing significant improvement. ETR was achieved in 99.1% (209) treatment-naïve patients and 98.9% (88) treatment-experienced patients. SVR rates were almost similar with 98% (208) achieving it in the treatment-naïve group and 96.6% (86) achieving it in the treatment-experienced group. Conclusion SOF in combination with RIB is safe and remarkably efficacious in the treatment of chronic HCV, genotype 3. Not only is this regimen associated with the elimination of viral replication but it also improved transaminase levels. Outcomes are rarely, if ever, affected by previous use of antiviral medications.

Background and Aims: Chronic Hepatitis C virus is the leading cause of morbidity and mortality. Conversion to liver fibrosis and decompensated liver cirrhosis is common if left untreated. Direct-acting Antiviral agents (DAA) may help in liver fibrosis associated burden. Considering the fact, this study aims to determine the comparative effect of combination therapy (Sofosbuvir and Daclatasvir vs. Sofosbuvir and Ribavirin) on liver fibrosis improvement using noninvasive marker AST platelet ratio index (APRI) score. Methods: A retrospective cross-sectional study was conducted on secondary data of patients who visited a private gastroenterology clinic during the year of 2017 and 2018 in Karachi, Pakistan. Our sample comprised of a total of 300 patients who presented for the first time to the clinic from various provinces. Results: Among all, 163 (54.3%) patients were treated with Sofosbuvir and Daclatasvir while 137 (45.6%) treated with Sofosbuvir and Ribavirin. The overall mean age and SD of patients was 41.1 ± 13.4 years and among them 64.6% (n = 194) were males. In both groups, treatment response showed negative HCV viral load after treatment, p <0.001. Levels of hemoglobin were significantly reduced in patients treated with Sofosbuvir and Ribavirin, 12.8gm/dL (11.5-14.2) vs. 11.4gm/dL (10.8-12.8), p value 0.03. Levels of total bilirubin significantly improved in patient received Sofosbuvir and Daclatasvir, 1.2mg/dL (0.4 - 1.8) vs. 0.6mg/dL (0.2 - 0.6), p value 0.001. Patients who treated with Sofosbuvir and Daclatasvir had significant improvement in APRI score (pre-treatment 1.26±0.17 vs. post-treatment 0.63±0.09, p value <0.001) in comparison with who treated with Sofosbuvir and Ribavirin (pre-treatment 0.92 ± 0.07 vs. post-treatment 0.43 ± 0.05, p value <0.06). Conclusion: In present study, we report that the value of APRI improved significantly after treatment with DAA particularly those who treated with Sofosbuvir and Daclatasvir, which may indicate that regression of fibrosis is achievable after removal of the causative agent.