MOLECULAR AND BIOCHEMICAL STUDIES ON HEPATITIS C PATIENTS RELAPSED AFTER SOFOSBUVIR TREATMENT

Hepatitis C viral infection is one of the most common diseases in Egypt in the 20^th century that leaded to liver diseases such as liver cirrhosis or hepatocellular carcinoma (HCC). sofosbuvir is one of the most successful direct-acting antiviral (DAA) that play an important role in treatment of HCV. Fifty thousand patients with HCV were admitted in Mabaret El-Asafra hospital, Alexandria, Egypt, during a duration period extended from Oct 2015 to Oct 2017. All patients treated with sofosbuvir and ribavirin for 6 months as first line therapy according Egyptian health authorities. At end treatment period with first line of therapy during the follow-up checking detected HCV by quantitative PCR in seventy patients. Liver enzymes for seventy patients were estimated after relapse. Seventy patients were treated with combined therapy sofosbuvir and simeprevir as second line therapy.  Liver enzymes and PCR  were estimated after treated with second line therapy. All our cohort treatment experienced was between 1^st and 2^nd therapy including monitoring for their liver functions after 1^st treatment, during relapse period and after receiving the 2^nd therapy. Patients that were treated with combination of sofosbuvir and ribavirin at the first therapy achieved SVR after 24 weeks, a decrease in liver functions (ALT & AST) 94% achieving normal values, while 6% had mid elevation in ALT; 84% had normal values of AST and 16% had abnormal results with a negative PCR results. After following up (4 w to 48w) 36 % had normal ALT, 64% had abnormal results; 11.2 % had normal AST, 89% were abnormal. Patients were relapsed in 48weeks, and their viral load ranged from 7.0 X 10¹ to 9.90 X 10⁶IU/m. After receiving the 2^nd therapy, patients achieved SVR in a period ranged from 4 weeks to 12 weeks with no apparent changes in ALT, AST values, while the viral load was negative in all patients. Combination therapy (sofosbuvir and simeprevir ) for 12 weeks in patients with genotype 4 infection is an effective regimen with an overall SVR  rate of 100%.