Schistosomiasis could play a role in transmission of HCV infection in dialysis patients

Abstract

Background: Both chronic HCV infection and schistosomiasis are major health problems in Egypt. The high prevalence of HCV infection in bilharzial patients had been postulated to be due to HCV transmission during past anti‐bilharzial parental therapy. The aim of the work was to study the possibility of transmission of HCV through the life cycle of schistosomiasis. Subject and Methods: The study included 180 patients divided into four groups: Group I: Included 40 patients with chronic renal failure (CRF) on regular hemodialysis (RH) with hepatic schistosmiasis (HS) and previous history of blood transfusion (BT). Group II: Included 40 patients with CRF on RH with HS and had no previous history of BT. Group III: Included 40 patients with CRF on RH with no evidence of HS and no previous history of BT. Group IV: Included 60 patients with HS with normal renal function and no previous history of BT. In addition 20 healthy persons were included as a control group. In addition to the routine investigations the patient groups were subjected to HCV Ab, HBsAg, HBcAb, HBcAg, anti bilharzial Ab, abdominal ultrasonography, rectal snip for patients positive for anti bilharzial Ab, and in‐situ hybridization (ISH) for HCV RNA and HBV DNA in the rectal snips positive for living schistosoma ova obtained from bilharzial patients positive for markers of HCV and HBV, respectively. Results: HCV Ab was detected in 92.5%, 65%, 55%, and 76.7% in groups I, II, III, IV, respectively, compared to 25% in the control group. Anti‐schistosomal Ab was detected in 75%, 50%, and 71.7% in groups I, II, and IV, respectively. A highly significant correlation was found between HCV Ab and anti‐schistosomal Ab positivity among all bilharzial groups (P < 0.01 in group I and P < 0.001 in groups II & IV). Rectal snips were positive for living schistosoma ova in 76.7%, 90%, and 81.4% of anti‐schistosomal Ab positive cases in groups I, II, and IV, respectively. Moreover, a highly significant correlation was found between HCV Ab and rectal snip positivity among the 3 bilharzial patients groups (P < 0.001 in groups I & II and P < 0.01 in group IV). On the other hand, there was no significant association between HBs Ag and either anti‐schistosomal Ab positivity or rectal snip positivity. ISH revealed HCV RNA in 26.3% of schistosomal ova‐positive rectal snips. In contrast, the examined biopsies were negative for hybridization of HBV DNA. Conclusion: Schistosomiasis might play a role in the transmission of HCV through its life cycle and this also may explain the significant association between HCV and schistosomiasis.