Efficacy of Direct Acting Anti-Viral Agents in Patients Infected with Chronic Hepatitis C Virus: A Single Center Experience

Background: Hepatitis virus C (HCV) infection is affecting millions of people globally with an estimated prevalence in Pakistan ranging from 4.5 to 8%. Advent of oral direct acting antiviral agents (DAAs) in combination therapy has made possible the treatment of decompensated cirrhosis secondary to hepatitis C (HCV) infection. Therefore, this study focused to evaluate safety and efficacy of direct antiviral agents (DAAs) in compensated and decompensated cirrhotic patients.

Materials and Methods: This cross sectional study was conducted in the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT) Karachi, from 1st September 2017 to 30th June 2018. Patients diagnosed with HCV, presenting in outpatient department were enrolled. All patients received Daclatasavir, Sofosbuvir and Ribavirin combination. Patient without cirrhosis and with cirrhosis received treatment for 12 and 24 weeks, respectively. End of treatment response was taken as primary end point. Statistical analysis was performed by SPSS version 20.0.

Results: Out of 180 patients, 88(48.9%) were male and 92(51.1%) were female, with mean age of 44.59±11.29 years. Majority had genotype 3 i.e., 145(80.6%). In this study population, 97(53.9%) patients were non-cirrhotic and received 3 months treatment while 83(46.1%) cirrhotic patient got 6 months treatment. Post- stratification observed that young patients have better treatment response rate than older individuals (p-=0.031) On the other hand, statistical insignificant association was observed between end of treatment response with regards to gender, duration of treatment, history of hepatic encephalopathy and ascites.

Conclusion: This study concluded that treatment with direct antiviral agents of Hepatitis C virus related chronic liver disease is effectual and has shown equivalent response in cirrhotic and non-cirrhotic patients. Age is an important factor affecting treatment response i.e, better response achieved in patient with less than 45 years.