Liver cirrhosis is an important risk factor for hepatocellular carcinoma. The reported annual incidence of HCC is about 3-8% in CHC cirrhotic patients. Based on the Cochrane systematic review there was no clear evidence,on the long-term clinical effects of DAAs in patients achieving SVR,as regard liver cirrhosis related HCC incidence. The aim of the study was to determine the incidence of HCC in chronic hepatitis C patients genotype IV with liver cirrhosis and advanced liver fibrosis after achieving SVR following DAA treatment in a prospective large cohort of HCV infected patients with long follow up.This was aprospective observational cohort study including 2372CHC patients with advanced liver fibrosis or cirrhosis receiving DAA therapy in out-patient clinics at the Egyptian Liver Research Institute and Hospital since January 2015. Liver fibrosis was assessed using transient elastography. Abdominal Ultrasonography and AFP measurement were done at baseline and follow up visits every 6 months, in addition to Triphasic abdominal MSCT when needed. Patients were followed up after achieving SVR12 for at least 12 months.HCC developed in 109 cases during the follow up period (mean 23.60±8.25 months). Overall HCC incidence was2.338/100 PY, 95% CI = 1.942-2.814. In patients with cirrhosis, the incidence of HCC was 2.917/ 100 PY, 95% CI = 2.407-3.535, while in patients with advanced liver fibrosis the incidence of HCC was 0.664/ 100 PY, 95% CI = 0.333-1.326.In conclusion,the incidence of HCC was reduced in chronic hepatitis C genotype 4patients with liver cirrhosis (F4) and advanced hepatic fibrosis (F3) who achieved SVR following DAA therapy.This article is protected by copyright. All rights reserved.