Oral Direct-acting antivirals (DAAs) are safe, highly effective altering disease burden and prognosis in hepatitis C patients. Sustained virologic response (SVR) is achieved nowadays in more than 90 percent of the treated patients and related to the improvements in functions of the liver, fibrosis plus survival. Furthermore, portal hypertension is thought to be improved with achievement of virological response, parallel to the improvements in hepatic inflammation and fibrosis.We aimed assess the recurrence rate of esophageal varices by long term follow up in patients treated with different DAAs regimens who had achieved SVR. We studied 176 Child A cirrhotic HCV patients who achieved SVR after DAAs treatment and had a history of endoscopic esophageal varices obliteration and were on maximum tolerated propranolol dose. They were subjected to follow up upper gastrointestinal endoscopy repeated every 6 months for 4 years. Fifty two patients (29.5%) had recurrence of esophageal varices observed during the 4-year follow up upper GIT endoscopy. On multivariate analysis, platelet count was the only significant variable, p-value=0.007*. HbA1C, HOMA IR, BMI 1 and BMI 2 showed non-significant differences between the studied groups. By ROC analysis, we identified baseline platelet count of 96.000/µL with 100% sensitivity (95% confidence interval [CI] [91-100%]) and 74% specificity (95% CI [65-81%]). Spearman correlation showed a positive correlation between AFP, age, AST, Bilirubin, creatinine, INR. Patients who achieved SVR post DAAs showed significant decrease in esophageal varices recurrence post endoscopic obliteration. Baseline platelet count was found to be a strong independent predictor for esophageal varices recurrence.
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