Subclinical hepatitis C virus infection in Egyptian patients with rheumatic diseases: a multi-center study

Safaa Ali Mahran,Fatma H Elnouby,M Z A Abu Rahma,M Hamdy,Saad Ghanem,Mohamed M Abdelkareem,M I Risha,Hesham Hamoud,Manal M Hassanien,A Fehr,Ahmad Hamdy,Alaa A A Mohamed,Abdelhafeez Moshrif,Dalia A Nigm,A Osman,Mohamed Hanafy,S Abd-Elsalam

doi:10.1186/s43166-020-00014-5

Abstract

BackgroundHepatitis C virus (HCV) infection is highly prevalent in Egypt. It was found to be 7.0% in a study done in 2015. There are some studies on the prevalence of HCV in rheumatoid arthritis, but to our knowledge, no previous study was done to detect it in other rheumatologic diseases. This study aims at detecting the prevalence of subclinical HCV infection in Egyptian patients with different rheumatic diseases. In the current study, eight hundred and three patients with different rheumatic diseases collected from five—geographically different—Egyptian rheumatology departments were studied. Patients with known current or previous HCV infection were excluded from the study. Screening for the positive anti-HCV antibodies was done for all patients. Screening for the presence of HCV ribonucleic acid (RNA) was done in patients with positive serology by reverse transcriptase-polymerase chain reaction.ResultsIn the studied population, 675 (84.1%) patients were women. The mean age [± SD] was 44.2 [± 12.9] years. Hepatitis C antibody positivity was found in 73 (9.1%) of the patients, while 67 (8.3%) were having positive HCV-RNA quantitative PCR tests. The highest prevalence of seropositive HCV was found in drug-induced vasculitis (DIV) and cryo-vasculitis (100%), while in RA, HCV antibodies and PCR were found to be positive in 9.1% and 8.3% of patients, respectively.ConclusionsDetection of the presence of HCV infection in 9.1 % of the studied middle-aged Egyptian patients with rheumatologic conditions points to the importance of screening for HCV in such population for early detection and intervention especially for those patients that are planned to start biologic therapy.

Highlights

Hepatitis C virus (HCV) infection is highly prevalent in Egypt
The spectrum of clinical manifestations of HCV infection can range from asymptomatic hepatitis flares to chronic hepatitis with hepatic decompensation, fulminant hepatic failure, and death in about 70–80% of cases due to liver cirrhosis and liver cancer
A total of 803 rheumatic patients from five different Rheumatology centers in Egypt were recruited in this study

Summary

Introduction

Hepatitis C virus (HCV) infection is highly prevalent in Egypt. This study aims at detecting the prevalence of subclinical HCV infection in Egyptian patients with different rheumatic diseases. Hepatitis C virus is a hepato- and lymphotropic agent that can trigger and sustain a clonal B cell expansion, Mahran et al Egyptian Rheumatology and Rehabilitation (2020) 47:1 and produce different autoantibodies causing a broad spectrum of autoimmune and lympho-proliferative disorders. This can complicate the differential diagnosis between primitive and HCV-related rheumatic disorders [6]. These manifestations may include frank autoimmune and rheumatic diseases (such as myalgia, arthralgia, arthritis, vasculitis, and sicca syndrome) which may dominate and complicate the course of the disease; treatment with biologic agents could reactivate latent HCV infection [9]

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