Fibrotic, metabolic and clinical improvements in patients with chronic hepatitis C treated with direct-acting antiviral therapy in a resource limited setting: a prospective cohort study

Hepatitis C virus (HCV) infection can lead to fibrosis, cirrhosis, and hepatocellular carcinoma. The advent of direct-acting antivirals (DAA) has transformed HCV treatment, achieving high cure rates. This study aimed to evaluate fibrotic, metabolic and clinical improvements in chronic HCV patients treated with DAA in low resource settings. An institution-based prospective cohort study was conducted from February 1 to July 30, 2023 to collect data face-to-face using a structured questionnaire and data abstraction sheet. Statistical analysis was performed using Statistical Package for the Social Sciences version 26. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Paired t-tests were used to compare baseline, third and sixth months post sustained virologic response (SVR) data, with statistical significance set at P < 0.05. A total of 102 patients were enrolled (mean age 47.67 ± 12.7 years); and most were female (65.7%). Significant reductions were observed in liver enzymes: Aspartate aminotransferase and Alanine aminotransferase decreased at three and six month post-SVR (P < 0.001). Hepatic synthetic function improved, with serum albumin rising and international normalized ratio declining at both follow-ups (P < 0.001). Total bilirubin decreased significantly at three (P = 0.007) and six months (P = 0.001). Model for End Stage Liver Disease scores declined at three and six months (P < 0.001). Aspartate aminotransferase to Platelet ratio index scores and Fibrosis-4index score, demonstrated significant reductions at both follow up (P < 0.001). Direct-acting antivirals therapy in chronic HCV patients resulted in a statistically significant improvements in liver function, clinical outcomes, and fibrosis levels by the third and sixth months post SVR.