Prevalence of Occult Hepatitis C Virus Infection among Egyptian Haemodialysis Patients

Background Hepatitis C Virus (HCV) infection is a global health problem. OCI is characterized by presence of HCV-RNA in the liver tissue only and/or Peripheral Blood Mononuclear Cells (PBMCs) with undetectable HCV-RNA or antibodies in the serum. Support for presence of this entity comes from the observation that HCV, even though a hepatotropic virus, can replicate as well at extrahepatic sites, including peripheral blood mononuclear cells. Objectives The current study evaluated the hidden infection of hepatitis C virus among patients on maintenance hemodialysis with negative ELISA and PCR by using PCR in mononuclear cells as a marker in these patients. Our study was done in Sharkia Governorate. Patients and Methods In our study, the 60 included subjects had an average age of 48.27 years with range from 19 to 77 years and included 33 males (55%) and 27 females (45%). The subjects had average dialysis duration of 6.51 ± 4.10years with range from 7 months to 19 years. Results Our study showed no statistically significant differences between occult HCV cases and negative cases in frequency of blood transfusion. There were no statistically significant differences between occult HCV cases and negative cases in splenomegaly, hepatomegaly or coarse liver but there was a statistically significant increase in frequency of severe ascites, moderate LL edema and jaundice among occult HCV cases compared to negative cases. There were no statistically significant differences between occult HCV cases and negative cases in urea, creatinine, ALT, AST or albumin. In our study total bilirubin>1.7 and direct bilirubin >0.4 were significant predictors for the presence of occult HCV in hemodialysis patients. Our study showed that there were no statistically significant correlation between viral load in PBMCs and laboratory findings among occult HCV cases. Conclusion Hemodialysis patients are liable for occult HCV infections with a considerable impact on their health. Total and direct bilirubin are predictors of presence of occult hepatitis C infection at cut-off values of 1.7 mg/dl and 0.4 mg/dl respectively.

Detection of Occult Hepatitis C Virus Infection in Patients Who Achieved a Sustained Virologic Response to Direct-Acting Antiviral Agents

Background Occult infection with hepatitis C virus (HCV) is defined as the presence of the HCV genome in either liver tissue or peripheral blood monocytes, despite constant negative results from tests for HCV RNA in serum. Objectives The aim of the study to detect the prevalence of occult hepatitis C Virus infection in patients who achieved a sustained virologic response (SVR) to direct-acting antiviral agents and to outline predictors of OCI. Patients and Methods This study included 100 patients with chronic HCV infection without liver cirrhosis attending to hepatitis C clinics at Ain Shams University Hospital, Ahmed Maher Teaching hospital and Elgomhorya Teaching Hospital.who received sofosbuvir (400mg) plus daclatasvir (60mg) daily for 12 weeks with or without ribavirin according to National committee to combat viral hepatitis (NCCVH) protocol. Results We tested peripheral blood for HCV RNA in PBMCs to detect OCI. Occult HCV was found positive in 12% of the studied cases. Occult HCV was positive more in male cases. Positive cases had significantly lower age, and higher total bilirubin, direct bilirubin, AST and ALT levels. Age had significant moderate diagnostic performance in predicting occult HCV, while direct bilirubin has significant low diagnostic performance in predicting occult HCV. Conclusion OCI following direct antiviral therapy may be present in some cases, and this may require further testing of patients with SVR particularly in younger male patients with persistantly high liver enzymes.

Prevalence of Occult Hepatitis C Virus Infection in Beta-Thalassemia Major Patients in Ahvaz, Iran

Background: Occult hepatitis C virus infection (OCI) is defined by the presence of HCV RNA in peripheral blood mononuclear cells (PBMCs) and liver tissue cells despite the absence of HCV RNA in plasma. Currently, OCI is classified into two types: seropositive OCI (anti-HCV positive and serum HCV-RNA negative) and seronegative OCI (anti-HCV and serum HCV-RNA negative). Beta-Thalassemia is described as a blood disorder, which decreases the synthesis of hemoglobin. Repeated blood transfusion is the standard treatment for patients with beta-thalassemia major (BTM) that increases the risk of exposure to infectious agents. This study aimed to investigate the prevalence of OCI among BTM patients.Materials and Methods: plasma and PBMCs were collected from 90 BTM patients and screened for HCV antibody using the ELISA kit commercially as the first step. Then nested-RT PCR was performed on extractions of plasma and PBMC. Positive samples of HCV RNA from PBMCs were sequenced and aligned to construct the HCV phylogenetic tree to assess the homology of sequences compared to the reference sequences retrieved from GenBank.Results: Seventy-nine out of 90 cases (87.8%) indicated negative results for HCV Ab (seronegative), while 11 patients (12.2%) were seropositive. HCV RNA was found in PBMCs samples of four patients (66.66%) with negative HCV Ab (seronegative) and two patients (33.3%) with positive HCV Ab (seropositive). HCV RNA was not detected in plasma samples of these six patients. Overall six out of 90 patients (6.7%) had OCI. HCV genotyping revealed that all six patients infected with HCV subtype 3a.Conclusion: We indicated the high frequency of OCI in BTM patients. Nevertheless, more attention is warranted, considering the importance of this infection. Also, further studies are necessary to determine the actual prevalence of OCI among BTM patients in Iran.