Abstract
Background: Hepatocellular carcinoma (HCC) is the major hepatic complication that may arise after many years of hepatitis C virus (HCV) infection. In Egypt, HCV represents the major health problem, also human cytomegalovirus (HCMV) is known as one of the highest un-resolved latent infections among general population. HCMV viremia in the co-infection with HCV may cause life threatening in HCC patients. Our study aimed to detect HCMV viremia in HCV–patients experienced HCC, and to investigate its role in disease worsening. Methods: In HCC patients, HCV-RNA viral load was determined by real- time polymerase chain reaction. In HCV-HCC patients, HCMV-DNA was detected by amplification of gB gene region using nested- polymerase chain reaction. Results: HCMV-DNA was detected in 4/73 in control subjects with prevalence rate of 5.4%, whereas HCMV–DNA was recorded in 24/75 HCV-HCC patients with prevalence rate of 32 %. Data on the level of alpha feto protein (AFP) was available for 59 out of 75 HCV-HCC patients, this enabled us to differentiate between low risk HCC group of 40/59 patients with AFP 500 ng /ml, from them HCMV-DNA was reported in 9/19 patients with prevalence rate 47.37%. High significant prevalence rate of HCMV-DNA (P < 0.001) among control and HCC subjects was reported. Significant change in HCMV – DNA prevalence between low and high risk HCC groups could not be achieved but tendency of higher prevalence rate in HCMV- DNA was observed towards HCC high risk group of patients. Conclusion: we illustrated information about HCMV/ HCV co-infection in HCC patients, which referred to the association of HCMV viremia with HCV-HCC patients, as well as the tendency of elevation in HCMV viremia from low to high risk HCC patients depending on AFP threshold of 500 ng/ml.
Highlights
Hepatocellular carcinoma (HCC) may develop and take its progressive nature after 20 to 40 years of chronic hepatitis C virus (HCV) infection
This result may refer to the higher association of human cytomegalovirus (HCMV) viremia with HCV-HCC patients compared with control subjects
interlukin 6 (IL-6) mRNA expression could be upregulated by HCMV infection, IL-6 production might depend on transcriptional factors (Dondorfer et al, 1994: Lepiller et al, 2011), that might be stimulated by HCMV and HCV, when IL-6 is secreted from activated monocytes
Summary
Hepatocellular carcinoma (HCC) may develop and take its progressive nature after 20 to 40 years of chronic HCV infection. HCMV genomic DNA is a linear, double-stranded molecule, surrounded by a protein lining, called matrix, which contains highly immunogenic phosphoproteins that can interfere with cellular cycle of the host cell This lining is surrounded by glycoproteins (gB, gN, gO, gH, gM, gL) essential for the virus to carry out its infectivity and entrance to the host cell. It has been proven that AFP serum concentration may peak in a parallel way with HCC tumor size (Kokudo et al, 2009) In such regard, The current united- network for organ sharing (UNOS) criteria for transplantation of the liver had considered patients of elevated AFP level > 500 as high risk patients taking priority in liver translation (Kemmer et al, 2006). Conclusion: we illustrated information about HCMV/ HCV co-infection in HCC patients, which referred to the association of HCMV viremia with HCV-HCC patients, as well as the tendency of elevation in HCMV viremia from low to high risk HCC patients depending on AFP threshold of 500 ng/ml
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