Purpose: To assess the efficacy and predictors of treatment response of chronic hepatitis C genotype 4 Egyptian patients with sofosbuvir and daclatasvir, with or without ribavirin.Methods: This prospective study enrolled 200 patients with chronic hepatitis C virus (HCV) genotype 4 infection who received sofosbuvir plus daclatasvir for 12 weeks, with the addition of ribavirin for treating cirrhotic patients. Immunological parameters such as natural killer (NK) cell percentage, phenotype, and serum C-X-C motif chemokine 10 (CXCL10) were evaluated prior to treatment and at the end of the treatment.Results: Overall, 92.5 % of the patients achieved sustained virological response at 12 weeks (SVR12), where the non-cirrhotic group had 96.29 % SVR12, while the cirrhotic group had 84.61 % SVR12. Nonresponders had lower pretreatment platelet count, higher CXCL10 levels, and lower baseline frequencies of NK cells and NK subgroup CD56- CD16+.Conclusion: Based on these results, the use of sofosbuvir plus daclatasvir with or without ribavirin for 12 weeks, is an effective regimen in the treatment of Egyptian patients infected with genotype 4 HCV. The predictors of non-response are advanced age, liver cirrhosis, lower pretreatment platelet count, higher level of CXCL10, lower baseline NK cells frequency and percentage of the dysfunctional subset CD56- CD16+. Keywords: Hepatitis C virus, Genotype 4, Sofosbuvir, Daclatasvir, Sustained virological response

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