Prevalence and Predictors of Occult Hepatitis C Infection in High-Risk Egyptian Populations

Mohammad M Sallam ,Hanan Samir Ahmed ,Sameh M Abdel Monem ,Hanan Soliman ,Essam A Wahab

doi:10.21608/aeji.2020.32501.1091

Abstract

Background and study aim: Direct acting antiviral agents (DAAs) altered hepatitis C virus (HCV) outcomes with a permanent cure in 90% of cases. However, HCV had not wiped out from all cases (1% ~ 15%), which represent occult HCV infection (OCI). The aim of this study is todetect prevalence and predictors of OCI in four high-risk groups. Patients and Methods: 196 participants were enrolled and assigned into four patients groups and one control group; group I (cryptogenic hepatitis), group II (HCV), group III (chronic HBV), group IV (ESRD), and group V (control group). HCV RNA testing in serum and in peripheral blood mononuclear cells, hepatic stiffness estimation and FIB-4 score calculation were done for all participants. Results: Significant differences were found among different study groups regarding frequencies of HTN (p < 0.001) and DM (p < 0.001), history of blood transfusion (p < 0.001), history of previous surgery (p < 0.001), as well as mean values of FIB-4 (p < 0.001) and fibroscan readings (p=0.002). OCI was found in 25 participants (12.7%), with different prevalence rates in different groups; being highest in group I (11/43, 25.3%), followed by group III (6/30, 20%). Among all participants, OCI was significantly associated multiple risk factors that include; history of blood transfusion (p=0.004), previous surgery (p=0.017), positive family history of HCV infection (p < 0.001), advanced fibrosis (p =0.015) and high FIB-4 score (p=0.016). Positive family history of HCV infection and history of blood transfusion were considered as independent predictors for OCI. Conclusion: Testing for OCI in high-risk populations and retesting in SVR cases might be needed to help in complete eradication of chronic HCV infection.

Highlights

Viral hepatitis is a common cause of mortality worldwide with hepatitis C virus (HCV) accounting for about half of this mortality [1]
Testing for occult HCV infection (OCI) in high-risk populations and retesting in sustained virological response (SVR) cases might be needed to help in complete eradication of chronic HCV infection
The aim of this study was to detect the predictors of OCI diagnosed by detecting HCV ribonucleic acid (RNA) replication in peripheral blood mononuclear cells (PBMC) in four high-risk groups ; those with asymptomatic sustained elevation of liver enzymes of unknown causes, those who gained SVR six months after the end of treatment with Direct acting antiviral agents (DAAs), patients with chronic HBV infection (CHB) and those with end stage renal disease (ESRD) on regular hemodialysis

Summary

Introduction

Viral hepatitis is a common cause of mortality worldwide with hepatitis C virus (HCV) accounting for about half of this mortality [1]. Egypt still has the highest HCV prevalence worldwide in different population groups, with evidence for continuous HCV transmission. Health care may be the culprit of past and present HCV transmission, with about half of individuals belonging to the clinical populations at high-risk being infected. With progressive scaling up DAAs treatment program, Egypt is likely to make ambitious steps towards HCV eradication by 2030 [4]. Direct acting antiviral agents (DAAs) altered hepatitis C virus (HCV) outcomes with a permanent cure in 90% of cases. The aim of this study is to detect prevalence and predictors of OCI in four high-risk groups

Objectives

Results

Conclusion