الفهرس 
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Abstract
Hepatitis C virus is a chronic infectious disease that can establish chronicity in up to 85% of the cases and may also lead to liver fibrosis, cirrhosis and HCV related hepato-cellular carcinoma. Egypt is considered one of the most HCV infected area worldwide with a viremic prevalence of 6.3%. In order to keep up with this challenge and to meet the global target for eliminating hepatitis C by 2030, the Egyptian Ministry of health has launched a mass program for HCV treatment called 100 million healthy life who aims to reduce the prevalence, morbidity and mortality related to HCV infection. The mass treatment program relies on the use of direct acting antiviral drugs which was recently FDA-approved for human use and had significantly revolutionized HCV eradication with SVR exceeding 95%.
In addition, the European Association for the Study of the Liver (EASL) and the American association for the study of liver diseases (AASLD-IDSA) recently recommended the use of Peg-IFN/Ribavirin free pangenotypic DAA regimens (Glecaprevir 300 mg/ pibrentasvir 120 mg for 8 weeks) or (Sofosbuvir 400 mg / velpatasvir 100 mg for 12 weeks). However, nowadays direct acting antivirals are facing many problems including viral resistance, relapse and some severe adverse effects rather than the absence of long-term safety profile. These obstacles facing current HCV control, together with the lack of HCV vaccine until now, have increased the demand for further investigation toward disease environment and host immunity that allows persistence of the chronic infection.
Moreover, several studies documented the ability of HCV to evade immunity by several immune alteration mechanisms. One of these suggested mechanisms is the accumulation of undifferentiated immature myeloid cells known as myeloid derived suppressor cells (MDSCs) (CD33+ CD11b+ HLA-DR-/low) which have been extensively studied in the field of cancer research as potent immunosuppressant cells that play a major role in cancer immune evasion. However, little is known about the significance of MDSCs in CHC patients.
In this study, we aimed to investigate the role of MDSCs in HCV infection and the impact of DAA treatment on HCV eradication and MDSC accumulation. We included Twenty-six untreated HCV patients, twenty-two HCV patients treated with sofosbuvir (400 mg/day) and Daclatasvir (60 mg/day) and fifteen healthy controls. We found highly statistically significant difference (p <.001) between study groups regarding MDSC frequency. The group of untreated chronic HCV patients (n= 26) showed the highest accumulation of MDSCs in peripheral blood with a median of 39.09%. Treated HCV patients (n=22) were also found to have increased MDSCs level with a median of 18.62% compared to normal healthy participants (n=15) 5.08%. We also found a significant negative correlation (rs -.570) (p.009) between MDSC frequency and IFN-ɣ concentration among treated HCV patients.