Hepatitis C Virus Core Antigen for On-treatment Prediction of Sustained Virological Response to Direct Acting Antivirals in Chronic Hepatitis C

Background and Aim: Cirrhotic patients have lower response rates to DAAs with increased frequency of adverse events. This study aims to evaluate the value of HCVcAg as an early predictor of SVR to DAAs in cirrhotic patients to justify the treatment and avoid side effects.

Patients and Methods: This prospective cohort study was conducted on 85 treatment-naive HCV cirrhotic patients who had fulfilled the inclusion and exclusion criteria of the National Treatment Protocol of chronic HCV infection. HCVcAg detection was done on 10th day of treatment. Predictivity of HCVcAg for SVR was assessed in terms of specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy rates. ROC curve was conducted to assess predictivity of HCVcAg as well.

Results: SVR12 was (91.76%). HCVcAg was negative in 79 patients; 78 of them achieved SVR, while it was positive in 6 patients; all of whom did not achieve SVR. HCVcAg had sensitivity, specificity, PPV, NPV and accuracy rates of 100%, 98.73%, 85.71%, 100% and 98.82% respectively in prediction of SVR. With AUC of 0.929. There was a positive strong significant correlation between HCVcAg and SVR12 (r = 0.898, P = 0.015).

Conclusion: HCVcAg is a sensitive, specific, accurate, easily available, and affordable on- treatment predictor of SVR in cirrhotic patients with chronic HCV with possible future treatment regimen modification to improve efficacy and tolerability in difficult to treat cirrhotic patients.