الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
HCV is the main cause of CLD in Egypt, and the second most common cause worldwide. Decompensated liver cirrhosis is diagnosed when one or more of the following complications have developed, ascites, jaundice, hypoalbuminemia, variceal bleeding or hepatic encephalopathy. In the past, it was not safe to treat chronic HCV patients with decompensared liver cirrhosis as they developed serious side effects compared to compensated liver cirrhosis patients or non cirrhotics. Nowadays, novel direct acting antiviral agents (DAAs) for chronic hepatitis C such as sofosbuvir (SOF), ledipasvir/sofosvuvir (LDV/SOF), daclatasvir (DCV) and others have minimal side effects and obtained sustained virological response (SVR) rates more than 90% and chronic HCV decompensated patients can be safely and effectively cured by these agents. Several invasive and non-invasive tools are used to evaluate and detect degree of liver fibrosis and cirrhosis as liver biopsy, transient elastography, shear wave elastography, fibrospect, FIB-4 score, APRI score, FI and FCI. Aim of this study is to evaluate impact of DAAs on indirect serum markers of liver fibrosis scores as FIB-4 score, APRI, fibrosis index, fibrosis cirrhosis index and MELD score and detection of degree of fibrosis and cirrhosis regression in patients with decompensated liver cirrhosis. This study includes 146 patients who were referred to hepatology outpatient clinic in Specialized Medical Hospital for DAAs therapy for chronic HCV. They are devided into 2 groups according to laboratory and radiological data each of 73 patients a follows : 1- First group :- patients received sofosbuvir and daclatasvir for 24 weeks. 2- Second group :- patients received sofosbuvir, daclatasvir and ribavirin for 12 weeks. This study includes 72 male patients and 74 femles with median age about 55 years old. Eighteen patients have DM with median HBA1C 7.25. There is significant improvement in liver function tests as ALT, AST, serum albumin, alkaline phosphatase, INR and bilirubin after DAAs therapy as compared with before treatment. Platelet count also shows significant improvement after treatment. There is obvious decrease in number of cases with ascites after DAAs therapy as compared with before treatment and also improvement of degree of ascites. Sustained virological response in this study is about 93% with 7 cases only show relapse after 12 weeks and 2 non responders. There is significant improvement in all fibrosis scores included in this study as FIB-4 score, APRI score, fibrosis index, fibrosis cirrhosis index, MELD score and CTP class. In relapse cases and non responders, there is worsening of all fibrotic indices after treatment as compared with before treatment mainly in FIB-4 score and FI.