Hepatitis C virus (HCV) infection has long been a major global health burden, historically associated with chronic liver disease, cirrhosis, and hepatocellular carcinoma. For years, interferon-based therapies were the backbone of treatment yet they were difficult to tolerate, required long treatment durations, and produced inconsistent cure rates.

The introduction of direct-acting antivirals (DAAs) changed the landscape entirely. DAAs offer cure rates exceeding 95%, shorter treatment durations, improved safety profiles, and greater accessibility. Yet, despite these advances, Saudi Arabia has faced a lack of large-scale real-world data describing the clinical impact of DAAs on local HCV patients.

A recent retrospective study from 2016–2023 helps fill this gap and provides encouraging evidence for both clinicians and policymakers.

Study Overview

Researchers analyzed 144 Saudi HCV patients treated with DAAs in an outpatient setting over a seven-year period (2016–2023). The study focused on:

• Genotype distribution.

• Treatment response.

• Biochemical improvements.

• Trends in HCV incidence.

This real-world cohort provides valuable insights into treatment success and epidemiological shifts in HCV within the country.

Key Findings

1. 100% Sustained Virologic Response (SVR) Achieved

All 144 patients (100%) achieved SVR meaning their viral load became undetectable after treatment. This remarkable outcome highlights the reliability and potency of modern DAAs.

2. Genotype Distribution

The genotype breakdown revealed:

• 38.9%: Genotype 4 (GT4) the most prevalent genotype in the region.

• 20.1%: GT1.

• 6.3%: GT2.

• 5.6%: GT3.

• 29.2%: Unknown genotype.

The high proportion of unknown genotypes underscores a need for expanded genotyping capacity, although many DAAs remain effective regardless of genotype.

3. Significant Improvement in Liver Enzymes

After treatment, patients showed marked biochemical improvement:

• ALT, AST, ALP → Significant reduction (p = 0.000).

• Conjugated bilirubin → No significant change.

These improvements reflect reduced liver inflammation and confirm the therapeutic impact of DAAs beyond viral suppression.

4. A 77% Reduction in HCV Incidence Over Seven Years

Between 2016 and 2023, HCV incidence in the studied population fell from 0.54% to 0.12%—a dramatic 77% decline.

This trend likely reflects:

• Successful DAA implementation.

• Improved screening.

• Better public health awareness.

• Possibly reduced transmission through medical and non-medical exposures.

Why These Findings Matter

Clinical Implications

• DAAs are highly effective across diverse genotypes.

• Rapid improvement in liver function parameters supports earlier treatment.

• Universal SVR rates reinforce their use as the standard of care.

Public Health Impact

• The significant drop in incidence suggests meaningful progress toward viral elimination.

• Data may guide national strategies under WHO’s HCV elimination goals for 2030.

• Understanding genotype patterns helps in resource planning and drug procurement.

Future Directions

Although the results are promising, long-term questions remain:

• How durable is SVR over decades?

• What is the residual risk of HCC in cured patients with advanced fibrosis?

• Can screening programs be further optimized?

• What additional strategies can push incidence even lower?

Further research especially multicenter and prospective studies will help refine treatment pathways and strengthen Saudi Arabia’s national hepatitis control efforts.

Conclusion

This seven-year retrospective study provides solid evidence that DAA therapy is highly effective for Saudi HCV patients, achieving universal cure rates and significantly improving liver health. Coupled with the striking decline in HCV incidence, these findings emphasize the transformative impact DAAs are having in the region.

As Saudi Arabia continues to expand access to antiviral therapy and enhance screening initiatives, it is well-positioned to move closer to the goal of eliminating hepatitis C as a public health threat.

Authors:

Fatimah Salem Alayidh, Alexander Woodman, Nawaf Yahya Zakary, Rehab Yusuf Al-Ansari, Sharjeel Chaudhry, Amal Omar Alsaadi, Khadijah Ahmad Alharbi, Batool Abdullah Alamri, Shahad Mousa Alhomud, Shahad Hassan Albather, Sarah Abdullah Bataweel, Nouf Ahmed Madkhali, Samira Jamaan Alzahrani, Zarmina Ehtesham.