In 2018, Egypt has started a campaign for mass diagnosis and treatment of HCV with sofosbuvir based regimens. The campaign managed over the past four years to diagnose and treat a huge number of patients with HCV at different grades of the disease with a rateof sustained virological response that exceeds 95%. The campaign was successful and managed to decrease the prevalence of HCV in Egypt and actually solve this national HCV problem. The reason for that is, DAA’s have fewer side effects than INF based regimens, the quality that makes them more tolerable and enhances patients’ compliance and make them more suitable to use even in patients with advanced liver disease. Before the national campaign started there were studies that raised concerns about the impact of use of DAA in patients with advanced liver disease and in patients with previous ablation of HCC. Those studies claimed that use of DAA can actually enhance carcinogensis i.e appearance of denovo HCC and recurrence of HCC after ablation. Those studies even claimed that the recurrence was found to be more extensive and aggressive and less responsive to treatment. The health authorities choose to proceed despite those concerns. The reason for this was, first, patients with chronic hepatitis who have not become cirrhotic yet and those who have a well-functioning liver were not supposed to have any risk. Those patients were previously eligible for interferon therapy with approximately 55% chance of achieving SVR. Another thing is, most patients with advanced liver disease and those with HCC were not eligible for interferon therapy. It became clear that those patients do not have an alternative therapy to help them achieve viral clearance. Finally, Viral clearance will not only stop further deterioration of their liver disease, but also will prevent the spread of the disease in the society. A metanalysis study published in 2017 analyzed the results of 41 studies that came with similar conclusions that DAA increase the risk of denovo and recurrent HCC and found no direct correlation between DAA and carcingensis. It also found that there are many individual risk factors for carcingensis that should be investigated before your patient starts DAA. This study brought the debate to an end. Wider scale studies were published after the initiation of the campaign based on data from the Egyptian patients and most of them were in favor of the used of DAA in patients with HCV and that the use of DAA was associated with a decline in the all-cause mortality. The studies also emphasized the role of understanding the risk factors of liver carcinogenesis in every individual patient so that patients at higher risk referred to tighter follow up schedules to detect focal lesions as early as possible.

TBA!!!