The Efficacy and Safety of Treatment of Chronic HCV Infection by Ombitasvir/Paritaprevir/Ritonavir with Ribavirin and its Effect on Complement C3 and C4 Levels

Abstract Background: Chronic hepatitis C virus (HCV) infection is a major health risk worldwide. The complications do not only involve the liver but extend to several extrahepatic areas due to its immunological effects on B cells and the complement system. Since 2014, directly acting antiretroviral drugs (DAAs) have revolutionized the way we treat HCV infection. Aim of Study: To determine whether treating patients with chronic HCV infection with combination of Ombitasvir / Paritaprevir / Ritonavir (OBV/PTV/r) and Ribavirin (RBV) is effective and determine its effect on serum complement (C) levels. Patients and Methods: Fifty patients with chronic HCV infection (Child-Pugh A) naïve to DAA treatment were in-cluded in this study; all patients received two tablets orally daily of OBV/PTV/r. Each tablet contains 12.5mg ombitasvir, 75mg paritaprevir, 50 mg ritonavir in addition to RBV 1000- 1200mg one tablet daily all for 12 weeks. Patients were followed-up monthly for 3 months, for side effects and labo-ratory tests. Laboratory measurements included HCV PCR at baseline and 24 weeks, alpha fetoprotein (AFP), C3, C4 levels at start of treatment and after 6 months. Liver function tests; alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin and albumin, besides international normalization ratio (INR), complete blood count (CBC) and serum creatinine were repeated at 4, 8,12 and 24 weeks from start of treatment. Results: All patients achieved sustained virological re-sponse at 24 weeks (SVR24) with minimal complications. There was a statistically significant increase in serum C3 and C4 levels (1.05g/L ± 0.29 to 1.26 g/L ± 0.27 and 0.24g/L ± 0.09 to 0.32g/L ± 0.07, respectively). There was a significant decline is ALT and AST levels (64.76U/L ± 34.82 to 25.58U/L ± 8.24 and 61.94U/L ± 25.73 to 23.3U/L ± 8.36, respectively); and although hemoglobin levels declined by end of treatment no patient required stopping medication or blood transfusion. Conclusion: Treatment of HCV infection by combination of OBV/PTV/r with RBV is effective and safe in eradicating chronic HCV infection. Successful treatment of HCV improves complement C3 and C4 levels in those patients.