Effect of direct antiviral agents on neutrophils to lymphocytes ratio in patients with chronic hepatitis C virus

 Neutrophils to lymphocytes ratio (NLR) is one of the most usefulness ratio to be systemic inflammatory markers to predict secondary occult hepatitis C infection (OCI) development after direct-acting antivirals (DAAs) therapy had been assessed in the blood of chronic hepatitis C patients (CHC) genotype 1. Herein, the usefulness of this ratio will be addressed in CHC genotype 4 Egyptian patients. Also, the correlation of this ratio with the parameters of liver functions will be studied. Patients and Methods: blood samples were withdrawn from non-treated CHC patients (n=31), treated patients with DAAs (n=40) as well as a group of healthy individuals (n=13). HCV-RNA, HCV-antibodies and the parameters of liver function tests together with platelets count and differential white blood cells assay were done for each individual. Results: The percentage of neutrophils in the blood of the treated group was highly significantly increased but the lymphocytic percentage was significantly decreased when compared with those of the non-treated patients (P<0.0002 and P<0.034, respectively).After DAAs treatment, neutrophils/lymphocytes ratio (NLR) was significantly increased when compared with that of the non-treated patients (P<0.01). In conclusion: as that of CHC patient’s genotype 1, NLR can be used to monitor response to DAAs in CHC patients’ genotype 4 as well in spite of absence of significant correlation with liver functions tests. The possible mechanism of ratio elevation involves viral eradication via DAAs.