Study on Outcome of Nucleotide Polymerase Inhibitor (Sofosbuvir) in Treatment of Chronic Hepatitis C Among Egyptian Cirrhotic and Non-cirrhotic Patients

Abstract

Chronic hepatitis C infection is a prominent and potentially devastating liver disease worldwide. In Egypt, where an estimated 15% of the population may have chronic hepatitis C, over 90% of the infections have been reported to be HCV genotype 4. The primary goal of HCV therapy is to achieve eradication of the HCV which is currently determined by a sustained virological response (SVR) as surrogate marker The recent appearance of direct-acting antiviral agents (DAAs) has changed HCV therapy. Nucleotide polymerase inhibitors are one class of these new medications. Sofosbuvir, a pyrimidine nucleoside analog inhibitor of HCV pangenotype NS5B polymerase has become the first drug in this class to be approved for clinical use. Sofosbuvir has been shown to be highly effective, safe and well tolerated as part of an antiviral regimen. The aim of this study is to evaluate the effect of administration of nucleotide polymerase inhibitor (Sofosbuvir) and Ribavirin in treatment of chronic liver disease due to HCV infection among Egyptian patients over 24 weeks and compare the outcome in cirrhotic and non-cirrhotic patients. In this study, patients included achieved high rates of SVR12 (97.5%); 39 out of 40 patients in this study achieved SVR12. Only one patient relapsed after finishing the treatment and did not reach SVR12. In this study, there was no significant statistical difference between SVR12 and degree of fibrosis among the studied patients. Also, there was no significant difference when comparing the degree of change of liver fibrosis by Fibroscan among the studied groups. Only 35% of cirrhotic patients and 30% of non-cirrhotic patients in this study showed improvement in the degree of fibrosis by Fibroscan after treatment, but non of the patients in both groups worsened. In this study, cirrhotic patients reported significant decrease of hemoglobin level, WBCs count, liver enzymes and AFP level after treatment when compared with those before treatment. Non-cirrhotic patients reported significant decrease in hemoglobin level and liver enzymes after treatment when compared with those before treatment. No patients were reported with hemoglobin level below 10 g/dl. In this study, the common reported adverse effects included headache, fatigue, nausea, cough, anemia, dyspepsia, insomnia and pruritis. The most common of those were headache in cirrhotic patients and fatigue in non-cirrhotic patients. Those adverse effects were mild to moderate in severity. Generally, the treatment was tolerable. No patients in our study discontinued