Direct-acting antiviral therapy in HCV patients: a retrospective study of the pre- and post-treatment impact in Saudi Arabia

BACKGROUND: Although direct-acting antiviral (DAA) therapy revolutionized hepatitis C virus (HCV) treatment, offering high cure rates and improved tolerability compared to previous interferon-based regimens, HCV remains a major global health problem, with a lack of empirical data on HCV in Saudi Arabia. This study aims to investigate the current understanding of the clinical impact of DAA on HCV infection by examining its effectiveness in reducing viral load and achieving sustained virologic response (SVR). METHODS: This retrospective study was conducted in n = 144 Saudi HCV patients, treated in an outpatient clinic and who received DAA treatment between January 2016 and December 2023. RESULTS: All included n = 144 (100%) patients achieved SVR and had undetectable viral load after treatment: n = 29 (20.1%) had GT1, n = 9 (6.3%) GT2, n = 8 (5.6%) GT3, n = 56 (38.9%) GT4. It was found that n = 42 (29.2%) had an unknown genotype. While successful completion of the regimen with 100% SVR resulted in a significant reduction in the mean liver enzymes alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphate (ALP) (p = 0.000), conjugated bilirubin levels did not change. Between 2016 and 2023, there was a significant decline in HCV incidence of 77%, falling from 0.54% to 0.12% of HCV cases during this period. CONCLUSIONS: In this real-world cohort, direct-acting antiviral (DAA) therapy achieved high sustained virologic response (SVR) rates across all HCV genotypes, with excellent tolerability and minimal adverse events. These findings confirm the effectiveness of DAAs in achieving viral eradication among patients treated at our center. CLINICAL TRIAL: Not applicable. This study was a retrospective observational analysis and was not registered as a clinical trial.