Background: Chronic HCV infection is a major global health problem. Liver biopsy still the gold standard tool for assessment of hepatic fibrosis, however, real time hepatic elastography assessment and FIB-4 score calculation may be valuable alternatives. Aim of the work: Clarifying whether, hepatic elastography assessment and FIB4-score calculation are good and acceptable alternatives for Liver biopsy for assessment of liver fibrosis in patients with chronic HCV infection. Patients and Methods: The study was carried out through seven months duration on sixty-five HCV infected patients who were eligible for standard of care direct acting antiviral medications. Routine laboratory workup, abdominal US, transient hepatic elastography assessment, FIB-4 score calculation and liver biopsy were done for all participants. Results: ANOVA study of participant's age, Hb %, platelets count, albumin, ALT and AST among fibrosis stages diagnosed by LB showed no significant differences regarding participant's age and Hb%, while, a significant difference regarding serum albumin (p =0.05) and highly significant difference were found regarding platelets count, serum ALT and AST (p=0.001, Key words: Hepatic elastography; FIB-4 score; Liver biopsy; Liver fibrosis; Chronic HCV