Abstract
Liver fibrosis and viremia are determinant factors for the treatment policy and its outcome in chronic hepatitis C virus (HCV) infection. We aimed to investigate serum level of inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and its relation to liver fibrosis and viremia in children with chronic HCV. ITIH4 was measured by ELISA in 33 treatment-naive children with proved chronic HCV and compared according to different clinical, laboratory and histopathological parameters. Liver histopathological changes were assessed using Ishak score and compared with aspartate transaminase-to-platelet ratio (APRI) and FIB-4 indices as simple noninvasive markers of fibrosis. ITIH4 was measured in a group of 30 age- and sex-matched healthy controls. ITIH4 was significantly higher in patients than in controls (54.2 ± 30.78 pg/mL versus 37.21 ± 5.39 pg/mL; P = 0.021). ITIH4, but not APRI or FIB-4, had a significant direct correlation with fibrosis stage (P = 0.015, 0.961, and 0.389, resp.), whereas, the negative correlation of ITIH4 with HCV viremia was of marginal significance (P = 0.071). In conclusion, ITIH4 significantly correlated with higher stages of fibrosis indicating a possible relation to liver fibrogenesis. The trend of higher ITIH4 with lower viremia points out a potential antiviral properties and further studies in this regard are worthwhile.
Highlights
Hepatitis C virus (HCV) infection is a serious health problem that may result in chronic hepatitis, cirrhosis, and hepatocellular carcinoma
Liver disease seems to be milder in children than in adults; the natural history of HCV infection acquired in infancy and childhood remains poorly characterized and the long-term outcome of the disease is still a matter of debate [2]
Our results showed that inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) serum levels increased successively as fibrosis progresses from F1 to F3
Summary
Hepatitis C virus (HCV) infection is a serious health problem that may result in chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is estimated that over 200 million people are infected worldwide, while 80% develop a chronic form [1]. Egypt reports the highest prevalence worldwide ranging from 8.7% in upper Egypt to 24.3% in lower Egypt with genotype 4 in more than 90% of those infected [4]. Studies of the magnitude of HCV infection in Egyptian children revealed a prevalence of 3% in upper Egypt and 9% in lower Egypt [5]. Liver disease seems to be milder in children than in adults; the natural history of HCV infection acquired in infancy and childhood remains poorly characterized and the long-term outcome of the disease is still a matter of debate [2]
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