ABSTRACT
Background: Hepatitis C virus [HCV] infection is considered a national progressing problem that threatens the life of Egyptian people as Egypt has the highest prevalence of HCV infection in the world with prevalence rates of 14.7 % of the adult population. HCV infection causes chronic hepatic inflammation and severe liver diseases, such as liver cirrhosis and hepatocellular carcinoma. Currently, HCV is curable, unlike HIV and HBV. Goals of therapy are to eradicate HCV infection to prevent hepatic cirrhosis, decompensation of cirrhosis, hepatocellular carcinoma [HCC] and death. End point of therapy: undetectable HCV RNA in a sensitive assay [<15 Iu /ml] 12 weeks sustained virological response [SVR12] and 24 weeks [SVR24] after the end of treatment
Aim of the Work: To assess the efficacy of DAAs in the treatment of HCV in Aswan Governorate; and to compare between the different combinations of DAAs +/- ribavirin +/-interferon which were available during the study period as regards efficacy and possible side effects in each treatment combination
Patients and Methods: This retrospective study was conducted in Aswan Fever Hospital, Aswan Hospital Health Insurance and Tropical Medicine Department Ain Shams University. Study population: Patients with chronic hepatitis C who received treatment in the period from January 2015 to July 2016. Group I: Triple therapy [Sofosbuvir + Ribavirin + Interferon] for 3 months. Group II: Sofosbuvir + Ribavirin for 6 months. Group III: Sofosbuvir + Simeprevir for 3 months. Group IV: Sofosbuvir + daclatasvir +/- Ribavirin for 3 months
Results: In Group I SVR was 74.3% ,Group II SVR was 60% ,Group III SVR was 85.7% and Group IV SVR was 100%
Conclusion: This is a large real-life report of the use of very low-cost generic medications for treating HCV-G4 within the largest treatment programme worldwide. The use of entirely generic SOF DCV combination with or without generic RBV was well tolerated and associated with high response rate in patients with different stages of liver disease. This can be an example for other countries of similar limited resources for managing their patients with HCV
ABSTRACT
Background: liver transplantation [LT] has emerged as the optimal treatment for cirrhotic patients with Hepatocellular carcinoma [HCC] because it cures both tumor and underlying cirrhosis. HCC could be downstaged or controlled by various anticancer therapies, which might bring them chance of undergoing a curative treatment such as LT
Aim of the Work: it was to evaluate the outcomes of HCC downstaged patients using transarterial hepatic chemoembolization [TACE] therapy to allow eligibility for liver transplantation
Patients and Methods: the study included all the cirrhotic patients who underwent TACE for downstaging of HCC to become eligible for liver transplantation at the period from 2008 to 2017 in Ain Shams Specialized Hospital. Al the patients underwent TACE to meet the Milan criteria for liver transplantation
Results: the etiology of cirrhosis and HCC in our patients was primarily Hepatitis C virus which is endemic in our country. All the cases were not eligible for liver transplantation because they were out of Milan criteria, therefore all the cases underwent TACE for downstaging of the tumor to be within the Milan criteria to become fit for liver transplantation. After undergoing TACE for downstaging, Patients underwent living donor liver transplantation, then they were followed up for detection of recurrence on the transplanted liver. Four of the twenty seven patients had recurrent HCC [14.8 %]
Conclusion: successful down-staging of HCC by TACE can be achieved in the majority of carefully selected patients and is associated with excellent posttransplantation outcome