Changes in Liver Fibrosis, Lipid Profile and Insulin Resistance in HCV Patients Who Received Antiviral Therapy
Changes in Liver Fibrosis, Lipid Profile and Insulin Resistance in HCV Patients Who Received Antiviral Therapy
Hepatitis C virus (HCV) is one of the major globally cause of death and morbidity.Chronic
 hepatitis C is the leading cause of end-stage liver disease, hepatocellular carcinoma and
 liver-related death in Egypt.It could be considered a special type of metabolic diseases
 involving insulin resistance (IR) which accelerates fibrosis and modulation of
 lipid-cholesterol biosynthesis with increased risk for ischemic heart diseases.It could be
 considered a special type of metabolic diseases involving insulin resistance (IR) which
 accelerates fibrosis and modulation of lipid-cholesterol biosynthesis with increased risk for
 ischemic heart diseases .Increased prevalence of IR and type 2 diabetes mellitus extensively
 reported in HCV infections
Hepatitis C virus (HCV) is one of the major globally cause of death and morbidity and recent
 estimates showed increase in its prevalence over the last decade to > 185 million infections
 worldwide. Prevalence HCV infection in Egypt is the highest in the world.Chronic viral
 hepatitis infection increases liver fibrosis and stiffness and is an important cause of liver
 cirrhosis. Chronic hepatitis C is the leading cause of end-stage liver disease,
 hepatocellular carcinoma and liver-related death in Egypt.It could be considered a special
 type of metabolic diseases involving insulin resistance (IR) which accelerates fibrosis and
 modulation of lipid-cholesterol biosynthesis with increased risk for ischemic heart diseases
 .Increased prevalence of IR and type 2 diabetes mellitus extensively reported in HCV
 infections.Interferon (INF) based therapy was used in chronic HCV patient and investigators
 reported that it's effective in eradicating HCV RNA and improving liver fibrosis. However,
 It's associated with several side effects.Novel direct antiviral agents (DAA) for chronic
 hepatitis C have entered clinical practice. This therapeutics has minimal side effects and
 achieves sustained virological response (SVR) rates of above 90% of patients and they are
 shorter and simpler regimens.Liver fibrosis severity assessment is important when staging
 chronic HCV and it reflects impact of serological viral eradication on hepatic damage and
 fibrosis. Although liver biopsy is the gold standard procedure for fibrosis assessment, but
 non-invasive new approaches have been strongly recommended for evaluation of fibrosis, mainly
 in HCV. They have no complications and have good diagnostic accuracy. One of the most used
 non-invasive mechanical methods based on ultrasound is transient elastography (Fibro Scan).
 Although association of baseline metabolic characteristics with treatment outcome has not
 been fully assessed for DAAs, this group was reported to result in improved rates of SVR and
 to reduce the predictive ability of these factors except for the baseline low density
 lipoprotein. The highest prevalence of HCV was reported in Egypt, where genotype 4 is
 responsible for 91% of infections and DAAs represented main line of treatment in most
 centers.Although the changes in lipid metabolism after treatment with DAAs were reported for
 other genotypes. It was not fully studied in genotype 4 infected patients.
Inclusion Criteria:

 -  Age > 18 ys.

 -  Disease status: patients with chronic hepatitis C infection, based on the presence of
 anti-HCV and detectable serum HCV-RNA for 6 months or more who had different grades of
 fibrosis (F) as estimated by fibroscan

 -  Treatment: treatment naïve patients who will receive direct acting antiviral drugs
 (Sofosbuvir and Daclatasvir ± ribavirin) for 12 weeks

 -  Negative hepatitis B virus surface Ag and HIV antibodies

 -  No history of hepatocellular carcinoma or development of hepatocellular carcinoma
 during the treatment period

 -  No other causes of chronic liver disease (alcohol consumption more than 80 g/day,
 hepatotoxic drugs, autoimmune hepatitis, primary biliary cholangitis, hemochromatosis
 and Wilson's disease).

 Exclusion Criteria:

 -  Diabetic patients.

 -  Patients using lipid lowering agents.

 -  HCV co-infection with hepatitis B virus(HBV) or human immunodeficiency virus(HIV)

 -  Presence of other causes of chronic liver disease (alcohol consumption more than 80
 g/day, hepatotoxic drugs, autoimmune hepatitis, primary biliary cholangitis,
 hemochromatosis and Wilson's disease).

 -  Patients with hepatocellular carcinoma