Impact of new direct-acting antiviral drugs on hepatitis C virus-related decompensated liver cirrhosis Mohamed Essa, Aliaa Sabry, Eman Abdelsameea, El-Sayed Tharwa and Mohsen Salama Background The benefits of treatment of hepatitis C virus with direct-acting antiviral drugs in patients with decompensated liver cirrhosis (DLC) are still unclear. Aim To evaluate the degree of improvement in hepatic decompensation events and quality of life (QOL) in treated patients with DLC. Patients and methods One hundred and fifty patients with hepatitis C virus-related DLC were included; 75 of these patients received treatment (group I) [sofosbuvir (SOF) with either daclatasvir or ledipasvir for 24 weeks without ribavirin (RBV) or for 12 weeks with RBV] and 75 patients did not receive treatment as a comparable group (group II). Patients who achieved a sustained virological response at 12 weeks were assessed in terms of decompensation events, model for end-stage liver disease score, Child–Turcotte–Pugh score, biochemical changes, and QOL (applied on Mcguill QOL questionnaire) before starting treatment and 6 months after end of treatment, and were compared with untreated patients. Results Forty-two (56%) patients received SOF/daclatasvir for 24 weeks without RBV and 19 (25.3%) patients received SOF/ ledipasvir for 24 weeks without RBV. The model for end-stage liver disease score improved in treated patients (mean change –1.73), but worsened in untreated patients (mean change + 11.8) before and after 6 months. Also, the Child–Turcotte–Pugh score improved significantly (P < 0.001). Serum albumin, prothrombin time, bilirubin, α-fetoprotein, and alanine aminotransferase improved in treated patients (P < 0.001). Health-related QOL improved in treated patients (mean change + 17.65) and worsened in untreated ones (mean change - 18.68; P < 0.001). Conclusion Treated patients with DLC showed an improvement in liver tests and health-related QOL. Longer durations of follow-up for decompensation events are needed. Eur J Gastroenterol Hepatol 31:53–58 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Introduction Since its discovery, hepatitis C virus (HCV) has remained one of the major health problems worldwide, with ∼ 130–170 million people estimated to be chronically infected with the virus globally according to the WHO in 2016 [1]. Egypt is considered has one of the highest incidences of this health problem as about 14.7% of the population is infected with the virus [2]. However, more recent epide- miological modeling studies carried out to assess the HCV disease burden in Egypt suggested a more conservative estimate, wherein about 7.3% of the population has been reported to have viremic HCV. This is mainly because of the mortality in the older age groups, who have the highest prevalence of infection [3]. Chronic hepatitis C occurs in 70–80% of those who contract the virus, which causes damage that may progress to cirrhosis in 20% of patients within 2–3 decades; a quarter of these patients will develop complications, such as hepatocellular carcinoma (HCC), portal hypertension, and liver decompensation, with an average 5-year survival rate of 50% [4]. Hepatic decompensation is negatively affecting both survival and quality of life (QOL). Moreover, patients with decompensated liver cirrhosis (DLC) related to HCV infection are increasing in number because of aging of patients and longer duration of infection; thus, liver transplantation remains the treatment of choice for these patients. However, the imbalance between the supply of organs available for transplantation and candidate patients represents a major limitation [5]. Viral therapy in this group of patients was particularly challenging and relatively contraindicated because of severe toxicity and poor sustained virological response (SVR) [6]. The current availability of direct-acting antiviral drugs (DAAs) in the treatment of HCV infection, replacing the interferon (IFN)-based regimens, has transformed the treatment strategy, with enhanced safety profile, vir- ological efficacy, and shorter treatment durations [7]. Effective antiviral therapy that results in SVR might positively alter the natural history of HCV-related DLC by reducing the incidence of HCC and decompensation events requiring liver transplantation [8]. Reports from different Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El Kom, Egypt Correspondence to Eman Abdelsameea, MD, Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El Kom 32511, Egypt Tel: + 20 100 241 5022; fax: + 20 48 223 4586; e-mail: eabdelsameea@liver-eg.org Received 9 March 2018 Accepted 2 May 2018 European Journal of Gastroenterology & Hepatology 2019, 31:53–58 Keywords: decompensated liver cirrhosis, direct-acting antiviral drugs, hepatitis C virus ’ Original article 0954-691X Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MEG.0000000000001250 53 Copyright r 2019 Wolters Kluwer Health, Inc. All rights reserved.