Comparison between Sofosbuvir, Ribavirin, Pegylated Interferon Alfa-2a versus Sofosbuvir, Ribavirin, Pegylated Interferon Alfa-2b in Treatment of Hepatitis C Virus in Egyptian patients

Abstract

Hepatitis C virus (HCV) infection is one of the major causes of chronic liver disease. According to recent WHO reports 180 million people worldwide are chronically infected with hepatitis C virus and more than 350,000 people die every year from hepatitis C related liver diseases; it is the principal cause of death from liver disease and the leading indication for liver transplantation in the United States (U.S.). The mortality related to HCV infection (death from liver failure or hepatocellular carcinoma) will continue to increase over the next two decades. HCV is known as the “silent epidemic” because patients may have no symptoms during the first 20-30 years after infection. However, the infection will slowly damage their liver over time. This feature of the disease, along with the lack of systematic screening policies, means that the majority of patients remain undiagnosed. As only 25% of patients with HCV have been diagnosed, this represents an inaccurate reflection of the true impact of the disease. 50- 85% of patients infected with HCV develop chronic hepatitis C (CHC) and are at risk for fibrosis progression. Approximately 20–30% of CHC patients will develop cirrhosis of the liver within approximately 20–40 years. Once cirrhosis is established the rate of hepatocellular carcinoma (HCC) development is 1–4% per year. Egypt has the highest prevalence of HCV in the world. It is estimated that about 15% of population are infected with hepatitis C. Egypt has the largest epidemic of hepatitis C in the world. HCV epidemic in Egypt is unique in the world and well documented in the international medical scientific literature. The percentage of Egyptians with HCV is 14.7%. The current population in Egypt is about 78 to 80 million. 14.7% of this population (0.147 X 78 million) is 11,466,000 persons who have been infected with this virus. This is ten times greater than any other country in the world. The prevalence of HCV in Western countries is less than 2%. The primary goal of HCV therapy is to cure the infection. A sustained virological response (SVR) is defined as undetectable HCV RNA 12 weeks (SVR12) or 24 weeks (SVR24) after treatment completion. The infection is cured in more than 99% of patients who achieve an SVR. The SVR is generally associated with resolution of liver disease in patients without cirrhosis. Patients with cirrhosis remain at risk of life-threatening complications; however hepatic fibrosis may regress and the risk of complications such as hepatic failure and portal hypertension is reduced. Recent data suggest that the risk of HCC and all-cause mortality is significantly reduced, but not eliminated, in cirrhotic patients who clear HCV compared to untreated patients and non sustained virological responders.