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, <0.001and <0.001 respectively). Post hoc study of the previous parameters between different fibrosis stages (Liver biopsy) showed no significant differences were found between F0 & F1, F0 & F2 and F1 & F2 regarding all parameters. No significant differences regarding Hb% and age but, highly significant differences were found between F0 &F3 as regard platelets count, albumin, ALT and AST. No significant differences regarding Hb% and age but, a significant difference and highly significant differences were found between F1 &F3 regarding serum albumin, platelets count, ALT and AST respectively. No significant differences regarding age and serum albumin but, highly significant differences were found as regard platelets count, ALT and AST between F2 &F3. Elastography readings agreed with liver biopsy in 4 out of 4 in F0, 26 out of 38 in F1, 9 out of 12 and 8 out of 11 in F3. Elastography readings in comparison to corresponding fibrosis stages readings by LB showed sensitivity (76.7%), specificity (100%), PPV (100%), NPV (96.7%) and accuracy rate (96.9%) with highly significant difference (p =0.001). While FIB-4 score readings in comparison to corresponding fibrosis stage readings by liver biopsy showed sensitivity (35%), specificity (91.1%), PPV (63.6%), NPV (75 %) and accuracy rate (73.8%) with highly significant difference (p =0.001). Conclusion: Hepatic elastography assessment and FIB-4 score calculation are rapid, accurate and sensitive tools for assessment of liver fibrosis in chronic HCV patients.