Long-term outcomes of treated chronic HCV compensated cirrhotic patients in Egypt

Abstract Background Hepatitis C virus (HCV) poses a major public health challenge in Egypt. Direct-acting antivirals (DAAs) are considered the optimal treatment for chronic HCV patients, given their high efficacy (sustained virologic response [SVR] > 90%) and minimal side effects. However, data on the association between DAA use and hepatocellular carcinoma (HCC) development remain controversial. Aim To assess the long-term effects of different Sofosbuvir-based DAAs on chronic HCV patients with compensated cirrhosis. Methods This longitudinal cohort study included 424 chronic HCV patients with compensated cirrhosis who were eligible for antiviral therapy according to national guidelines. Baseline and follow-up laboratory tests and abdominal ultrasounds were conducted over a median follow up period of 200 weeks. Results Follow-up showed significant improvements in transaminase levels, albumin, and alpha-fetoprotein (AFP), all with P -values < 0.01, along with a decrease in hemoglobin levels ( P < 0.01). During follow-up, 39 patients (9.2%) developed HCC, all of whom had low albumin levels. Conclusion DAA treatment was not associated with a worsening biochemical profile. However, the occurrence of HCC in cirrhotic patients post-DAA treatment highlights the need for close monitoring and regular HCC screening after treatment.