Background and study aim: The real life effect of anti-HCV direct acting agents (DAAs) on the hematologic profile and serum ‎levels of vitamin B12 and folic acid was not yet fully studied‎.
Patients and Methods: Between March 2018 and March 2019, a prospective study was designed at El-Rajhi University ‎Hospital, Egypt, to randomly select HCV-related child A cirrhosis that were eligible for DAAs.  All ‎patients received oral sofosbuvir (SOF; 400 mg) plus daclatasvir (DCV; 60 mg) once daily plus weight ‎based ribavirin (RBV): 1,000 mg/day if < 75 kg and 1,200 mg/day if ≥75 kg; regimen for 12 weeks. ‎Hematologic profile, folic acid and B12 levels were assessed twice; before the start of therapy and at ‎the end of week12 by electrochemiluminescence immune-assay.
Results: A total of 25 patients were enrolled (age 50.11 ± 7.89 years, 15 males). The majority had no ‎co morbidities. Hematologic profile in pre and post therapy showed significant decrease in hemoglobin ‎levels after treatment (13.1 ± 0.93 Vs 11.15 ± 0.90, respectively; p=0.02). Folic acid level showed a ‎significant decrease (14.56 ± 4.45 Vs 9.06 ± 2.11; respectively, p=0.01) and vitamin B12 levels showed ‎a minor increase (345.09 ± 55.98 Vs 355.19 ± 33.45; respectively, p=0.08)‎.
Conclusion: Significant changes in the kinetics of B12 and folic acid were reported during the course of DAAs in ‎management of chronic HCV with cirrhosis. Further large cohort and randomized controlled trial ‎needed to study the effect of add-on these vitamins on the response rates‎.