Chronic HCV Egyptian Patients Research Articles

Assessment of Galectin 3 as a New Biomarker of Liver Fibrosis in Chronic HCV Egyptian Patients and its Correlation to Transient Elastography, FIB-4 Index, and APRI Score

Abstract Background Invasive liver biopsy is the current method for the assessment of liver fibrosis. In search of noninvasive alternatives, galectin-3-binding protein (G3BP) was introduced as a candidate-marker of hepatitis C-related fibrosis based on serum proteomics. Aim of the Work to evaluate serum Galectin-3 as a marker of liver fibrosis and correlate it to the stage of fibrosis assessed by FibroScan, FIB-4 index and APRI score Patients and Methods This was prospective study, was carried out on 30 patients with liver fibrosis/cirrhosis due to chronic HCV inthe Hepatic Virology Unit and the gastroenterology department of Ain Shams university hospitals and 30 health controls with normal, non fibrotic and non cirrhotic, liver, from January 2022 to June 2022 Results There were high significant difference between both groups as regard Serum level of Galectin-3 and APRI score. Conclusion Serum level of galectin-3 was highly expressed in chronic HCV Egyptain patients and positively correlated to FIB-4 index, APRI score and fibroscan.so the serum level of galectin-3 beside other modalities, lab investigations and clinical examination may guide us about the progression to fibrosis and cirrhosis in those patients. In these patients, if galectin-3 levels were found to be high, serum alpha-feto protein level and ultrasonographic examination could be repeated at more frequent intervals. This may also guide us in terms of the treatment plan. Measurement of galectin-3 in sera of large number of patients and follow up may pave the way to pick up early fibrosis and showed its prognostic effect.

Safety and Efficacy of Directly Acting Antiviral Drugs in Treatment of Chronic HCV Egyptian Patients

Abstract Background The emergence of direct antiviral agents (DAAs), and the campaign done by the National Committee for Control of Viral Hepatitis (NCCVH) have reduced chronic hepatitis C (CHC) prevalence in Egypt. Objectives evaluate the efficacy and safety of used DAAs in affiliated centers. Methods an observational prospective and retrospective study including140 eligible patients from October 2017 till December 2019 and who were either starting treatment or during follow- up for 1 year after the end of therapy (EOT). Patients were divided according to the treatment regimen into Group I (SOF/DAC for 12 weeks), Group II (SOF/DAC/RBV for 12 weeks), Group III (SOF/SIM for 12 weeks), Group IV (SOF/DAC for 24 weeks) and Group V (SOF/DAC/RBV for 24 weeks). Results DAAs were effective in all groups. Adverse effects occurred in 54 patients (38.6%). The most common complications that occurred were ascites (n = 18) followed by jaundice (n = 17) and hepatocellular carcinoma (HCC) (n = 14). Almost all patients (97.1%) in group IV complained of adverse effects compared to other groups with a statistically significant difference (p < 0.001). Hematemesis occurred in one patient among the whole groups and this patient had been in group IV. There was also a significantly higher proportion of ascites (38.2%) in group IV compared to other groups (p < 0.01), however no significant differences between groups regarding HCC and renal impairment (RI) (p-value= 0.316 and 0.758 respectively) were found. 49 naïve patients suffered from side effects, 31 patients were in group IV, followed by group I (n = 7) then group II (n = 6). 5 experienced patients reported side effects. RI was the most reported side effect (12.5%) among interferon (IFN) experienced and SOF/DAC experienced patients and who were treated among group IV and group V. Hepatic encephalopathy was equally reported (12.5%) in IFN experienced and SOF/RBV experienced patients among group IV or group V. Ascites (6.3%) and jaundice (6.3%) also were reported among group IV. No experienced patient has complained of hematemesis or HCC. Conclusion SOF/RBV treatment for 24 weeks had many side effects and should be used with caution.

Angiopoietin-2 as a Predictor of Fibrosis Regression in Hepatitis C Virus-Patients after Direct Acting Antiviral Drugs

Abstract Background HCV infection is a major health concern. Disease progression to fibrosis, cirrhosis, and HCC is aided by the persistence of inflammatory reactions and cellular damage. Moreover, angiogenesis was found to have a substantial pathogenic role in disease progression. Serum Angiopoietin-2 appears to be correlated with liver stiffness in chronic HCV and its elevation is linked to disease progression from chronic hepatitis to cirrhosis. Aim of the Work The aim of this study was to evaluate the role of serum Angiopoietin-2 in the prediction of regression of fibrosis in chronic HCV patients receiving direct-acting antiviral agents. Patients and Methods Forty Egyptian chronic HCV patients for whom direct-acting antiviral agent (DAA) therapy was planned were included. All patients underwent assessment twice, at baseline and at SVR12, for standard laboratory tests, measurement of fibrosis using FibroScan, FIB-4 and APRI scores, and Angiopoietin-2 level. Results Among 40 patients; 26 (65%) are males and 14 (35%) are females. Their age is ranged between 35 and 60 years old with a mean age of 52.35 ± 6.08 and a median of 53.0 (50.0 – 57.0). The HCV-RNA titer is ranged from 3.60 to 7.20 log IU/mL with a mean titer of 5.99 ± 0.87 before treatment. The median is 6.20 (5.30 – 6.65). There was a significant improvement concerning the fibrosis stage after DAA treatment. Liver fibrosis indices were significantly associated with regression of liver fibrosis stage based on FibroScan data after DAA therapy. Liver size, spleen size and portal vein diameter were improved significantly after successful HCV eradication by DAAs. There was improvement in the Child-Pugh score after successful HCV eradication by DAAs but the difference was no statistically significant (p = 0.500). Baseline Ang-2 was statistically significant after successful HCV eradication by DAAs (p < 0.001). Overall, there was a positive significant correlation between Ang-2 and all the fibrosis stages (p = 0.001) and there was a statistically significant higher mean of Ang-2 in higher stages of liver fibrosis before treatment. Indeed Ang-2 increase significantly when the fibrosis stage increased and vice-versa before treatment. Ang-2 in higher stages of liver fibrosis after treatment. Indeed Ang-2 increase significantly when the fibrosis stage increased and vice-versa after treatment. The correlation between Ang-2 and fibrosis group (F0, F1, F2 & F3) were significant and the correlation between Ang-2 and the liver fibrosis stage (F4) were also significant before treatment. The correlations between Ang-2 levels and fibrosis group (F0, F1, F2 & F3) were significant as well as the advanced liver fibrosis (F4) after DAA therapy. Conclusion Angiopoietin-2 can be a useful predictor of fbrosis regression in chronic HCV patients receiving direct acting antiviral agents. Elevated baseline Angiopoietin-2 and advanced ibrosis stages may predict non-regression of liver fibrosis.

Serum retinol-binding protein 4 as a predictor of fibrosis regression and response to direct-acting antiviral drugs in chronic hepatitis C virus patients

BackgroundHepatitis C virus is the underlying cause of chronic hepatitis which frequently progresses to cirrhosis and hepatocellular carcinoma. In addition, HCV is thought to cause steatosis, dyslipidemia, insulin resistance, diabetes, obesity, and cardiovascular events. The aim of this study is to evaluate the role of serum RBP-4 in the prediction of fibrosis regression and the response of treatment among chronic HCV patients receiving direct-acting antiviral agents.MethodsThis study included 40 chronic HCV Egyptian patients, divided into two groups: Naive cases, 20 chronic HCV patients before starting first line of treatment; Relapser cases, 20 chronic HCV patients who were non-responders before starting second line treatment; and 10 healthy subjects as control. Laboratory investigations including complete blood count, full hepatic profile, fibroscan assessment, and retinol-binding protein-4 level at baseline and re-assessed 12 weeks after the end of treatment [sustained virological response SVR12]. Student T test, analysis of variance, chi-square, Tukey’s test, and Pearson correlation coefficient tests were used for statistical analysis.ResultsBaseline retinol-binding protein-4 level was significantly higher in the naïve case group than in the relapser and control groups with a P value of P value of < 0.001. All the naïve patients had 100% SVR12, only 90% of the relapser group achieved SVR12. A significant reduction in retinol-binding protein-4 and fibrosis staging and measurements by fibroscan among all studied patients were noted after receiving direct acting antivirals (P value < 0.001). Retinol-binding protein-4 levels before and after treatment were significantly lower among F4 patients in comparison to those of F1–F3 patients (P value 0.002, 0.009, respectively). The best cutoff value of retinol-binding protein-4 in the prediction of liver cirrhosis (F4) was ≤ 46 pg/ml with sensitivity of 100% and specificity of 66.67%.ConclusionSerum retinol-binding protein-4 was found to be higher in chronic HCV infection with a significant reduction after successful eradication. Its level is much lower in cirrhotic patients [F4]. As a result, retinol-binding protein-4 may have a promising role in assessing direct acting antivirals response, as well as a prognostic value in predicting liver cirrhosis.

Response to Directly Acting Antiviral Drugs in Chronic HCV Egyptian Patients Recovered from Low Grade B-Cell Non Hodgikan Lymphoma

Response to Directly Acting Antiviral Drugs in Chronic HCV Egyptian Patients Recovered from Low Grade B-Cell Non Hodgikan Lymphoma

Impact of HCV ns5a resistance associated substitutions on treatment outcome of chronic HCV in daclatasvir-based antiviral regimens

Background: RASs have direct relation to the treatment outcome in chronic HCV patients receiving DAAs. Aim and objectives: to evaluate prevalence of NS5A HCV RASs and their impact on the treatment outcome in daclatasvir-based antiviral regimens in a cohort of Egyptian patients. Subjects and methods: This study was conducted on 40 Egyptian chronic HCV patients at the virology unit of Cairo Fatemya hospital. The study participants were recruited from cases attending the virology unit of Cairo Fatemya hospital in the period from 1/11/2019 to 1/6/2020. Those patients were divided to two equal groups: responders and non responders (20 patient each).Result:Significant difference was found between the two groups as regard RAS in NS5A region in amino acid position 332 (K substitution was detected in responders while E substitution was detected in non-responders), There was a significant difference between the two groups of studied patients as regard RAS in NS5A region in amino acid position 28 (L substitution was found in responders while M substitution was found in non-responders).Conclusion; Although our results showed that RASs against NS5A and NS5B inhibitors have impact on treatment outcome, this finding needs to be confirmed by a larger study.

Angiopoietin-2 as a predictor of fibrosis regression in chronic hepatitis C virus patients after direct-acting antiviral drugs

BackgroundHCV infection is a major health concern. Disease progression to fibrosis, cirrhosis, and HCC is aided by the persistence of inflammatory reactions and cellular damage. Moreover, angiogenesis was found to have a substantial pathogenic role in disease progression. Serum Angiopoietin-2 appears to be correlated with liver stiffness in chronic HCV and its elevation is linked to disease progression from chronic hepatitis to cirrhosis. The aim of this study was to evaluate the role of serum Angiopoietin-2 in the prediction of regression of fibrosis in chronic HCV patients receiving direct-acting antiviral agents. Forty Egyptian chronic HCV patients for whom direct-acting antiviral agent (DAA) therapy was planned were included. All patients underwent assessment twice, at baseline and at SVR12, for standard laboratory tests, measurement of fibrosis using FibroScan, FIB-4 and APRI scores, and Angiopoietin-2 level.ResultsStatistically significantly higher levels of baseline Ang-2 were detected with the progression of fibrosis stages with a p-value of <0.001. The best cutoff value of baseline Ang-2 in discrimination of liver cirrhosis (F4) from F0-F3 was > 630 pg/ml with 85.71% sensitivity and 84.85% specificity. A statistically significant decline of Ang-2 (from 464.3±237.2 pg/ml to 401.3±277.1 pg/ml) was noted after the achievement of SVR12 with a p-value < 0.001. Regression of liver fibrosis in this study is defined as a decrease of more than or equal to one stage in liver fibrosis. Lower baseline fibrosis stages and other non-invasive scoring systems (FIB-4 and APRI scores) were associated with regression of fibrosis following successful DAAs treatment. However, higher baseline Ang-2 levels were significantly associated with non-regression of fibrosis, and at a cutoff of >680 pg/ml, it might predict non-regression of fibrosis after successful eradication of HCV with DAAs with 93.33% sensitivity and 70% specificity.ConclusionsAngiopoietin-2 can be a useful predictor of fibrosis regression in chronic HCV patients receiving direct-acting antiviral agents. Elevated baseline Angiopoietin-2 and advanced fibrosis stages may predict non-regression of liver fibrosis.

Vitamin D Receptor Gene Polymorphisms and the Risk of Chronic Hepatitis C Related Hepatocellular Carcinoma in Egyptian Population

Background: Small percentage of hepatitis C (HCV) patients develop hepatocellular carcinoma (HCC) during their lifetime, suggesting that genetic factors might modulate HCC development. Numerous variations on the vitamin D receptor gene (VDR) have been recognized in human cancers. The majority of them cause VDR to be unable to bind to 1, 25-OH-D. The aim of the present work was to investigate the relation of VDR FokI (rs2228570), BsmI (rs3782905) and ApaI (rs7975232) gene polymorphisms and the risk of HCC development in chronic HCV Egyptian patients. Methods: A total of 311 Egyptian patients were enrolled for this study. They were divided into 3 groups: 103 patients with liver Cirrhosis, 107 patients with HCC and 101 normal healthy subjects as the control group. Human genomic DNA Extraction was carried out using QIAamp® DNA Blood Mini Kit (QIAGEN) Genotyping of VDR ApaI (rs7975232) single nucleotide polymorphism (SNP) was carried out using real-time PCR TaqMan allelic discrimination assay with allele-specific designed fluorescent MGB probes. Results: Patients with HCC had a higher frequency of ApaI CC genotype (P=0.035) CI (0.031-0.038). Patients with HCC carried a higher ratio of ApaI CC genotype compared to those with liver cirrhosis (x2=5.4 and P = 0.03) or controls (x2=6.8 and P = 0.01). Univariate analysis revealed that age, lower platelet count (&lt;150×103/μL), higher AFP (&gt;100 ng/ml), and ApaI CC genotype were the factors significantly associated with the development of HCC. Stepwise logistic regression analysis showed that all were independent predictors. Conclusion: ApaI CC VDR gene mutation is an independent risk factor for HCC development in Egyptian Cirrhotic HCV patients.

Characteristics of De novo Hepatocellular carcinoma (HCC) in Chronic HCV Egyptian patients received Direct Acting Antivirals (DAAs) therapy: A pilot study

Abstract Background Direct-acting antiviral agents for chronic hepatitis C have initiated a revolution in the management and control of this important liver disease with cure rates over 90%. However, it has been suggested that HCC may occur or recur in patients with chronic HCV infection who received DAAs therapy. Aim To compare characteristics and behavior of de novo Hepatocellular carcinoma (HCC) in chronic HCV patients who received direct acting antiviral treatment with those who didn't receive DAAs . Patients and methods The current study was conducted on patients with de novo HCC presented at HCC clinic, Tropical medicine department Ain Shams University Hospitals between December 2017 and December 2018, aged (18-70 years old) . Total number of HCC cases visited the clinic during the study period was 416 patients. 160 patients with de novo HCC were enrolled in the study fullfiling the inclusion criteria and divided to two groups, 80 patients with HCC who received Direct antiviral treatment, the other 80 patients who didn't receive Direct antiviral treatment. Results Unlike some previous concerns about increased biologic aggressiveness of HCC after DAA treatment, resulting in infiltrative pattern and multinodular HCC outside Milan criteria, our results on de novo HCC after DAAs were mostly single, small, and diagnosed in early stages, resulting in BCLC stage 0-B in the majority of patients. There were no statistical differences regarding total size of tumor,or vascular invasion or AFP, but there’s a statistical difference in largest size of HFLs that was more significant in group (A) P = 0.04 The mean Child score was 5.75 in group A, with 61 patients (76.3%) were Child class A,19 patients (23.8%) were Child class B and 0 patients were child C. For the patients in group (B) the mean Child score was 6.15, with 50 patients (62.5%) were Child class A, 26 patients (32.5%) were Child class B and 4 patients (5%) were child C. Conclusion The current study shows no differences between the 2 studied groups as regard tumor aggressiveness, but data on risk of HCC and behaviour after DAAs is still conflicting and further studies are needed

Study of the effect of direct acting antivirals (DAAs) on fibrosis in chronic hepatitis C patients using transient elastography

Back ground: As DAA agents are leading to enormous cure rates, so identifying and monitoring patients who remain at a high complication risk after achieving SVR continue to be a critical issue. Numerous validated methods for noninvasive measurement of liver fibrosis can be used in the management of HCV infection. Methods study: A total of 50 Egyptian chronic HCV patients eligible for treatment with DAAs were enrolled in this prospective study. All subjects selected from Virology Unit of Tropical Medicine Department, Faculty of Medicine, Beni-Suef University received DAAs (SOV DCV) the endpoint was a sustained virologic response at 12 (SVR12) weeks post-treatment. All participants were evaluated non-invasively by Liver Stiffness Measurement (LSM) by Fibro Scan before DAAs treatment, and 6 months post-treatment. Results: SVR achieved by DAAs therapy was 96 % and was associated with significant improvement (p ˂0.05) of non-invasive fibrosis markers (FIB-4, APRI score, and LSM by Fibro Scan) from baseline compared to 6 months post-treatment. Using fibro scan regression of fibrosis in 30/45 patients (66%). Liver inflammation and synthetic functions also improved on follow up 12w and 6m post treatment. Conclusion: Regression of Liver inflammation and fibrosis in chronic hepatitis C patients post treatment with SOF DCV.

Changes in Sustained Treatment Response in Relapsed Chronic Hepatitis C Egyptian Patients on Directly Acting Antiviral Agents with Increased Insulin Resistance

Background: It is known that patients with high insulin resistance (IR) have a slower rate of decline in the viral load of HCV RNA compared to patients with low IR. Objective: to evaluate relation between insulin resistance on sustained treatment response with direct oral antiviral drugs on relapsed Egyptian chronic HCV patients. Patients and Methods: 50 patients with chronic hepatitis C met inclusion criteria divided into Group I were non responders to treatment and achieved sustained virological response (SVR) at week 12 on retreatment and Group II were non responders to treatment and failed to attain SVR after 12 weeks of retreatment. All participants received the direct antiviral therapy (DAA) sofosbuvir and daclatasvir for 12 weeks. HOMA-IR was calculated and PCR was done before treatment, at end of treatment, 12 weeks and 3 months after end of treatment. Results: there was a highly significant correlation between HOMA-IR and liver enzymes, lipid (P<0.01) and significant relation between HOMA-IR and BMI and waist circumference. After 6 months of treatment there was highly significant increase in insulin sensitivity and decrease in insulin resistance in patients after eradication of HCV (P<0.01). 12 cases of insulin resistance pretreatment and after 6 months: 3 cases HCV -ve became non-insulin resistant, 2 cases HCV -ve became insulin resistant, 2 cases of HCV -ve developed DM and 5 cases had no changes (still insulin resistant). Conclusion: prevalence of insulin resistance and diabetes mellitus in patients with chronic hepatitis C was due to multiple causes and clearance of HCV infection improves insulin resistance; not directly related to DAA.

Changes in serum interferon-γ-inducible protein-10 levels and liver stiffness among chronic hepatitis C Egyptian patients in response to directly acting antiviral agents.

Interferon-γ inducible protein-10 (IP-10) is chemokine biomarker of liver inflammation, elevated in patients with chronic hepatitis C infection. Investigating if changes in serum IP-10 levels in response to directly acting antiviral agents (DAAs) treatment for chronic HCV patients are paralleled by changes in liver stiffness measurements (LSM), and assessing role of using serum IP-10 as a noninvasive accurate method to predict changes in hepatic necro-inflammation and fibrosis. A prospective observational study included 92 Egyptian chronic HCV patients, who received treatment with sofosbuvir with daclatasvir regimen. Patients were classified into two groups; group I (53 patients) with non to mild significant liver fibrosis (F0-F1), and group II (39 patients) with significant to advanced liver fibrosis (F2-F4). Fibroscan and serum IP-10 were assessed pretreatment and 3 months after end of treatment. All patients achieved SVR. Both IP-10 and LSM showed significant decline after treatment in both groups. No significant correlation was found between changes in LSM and IP-10. IP-10 detected liver cirrhosis at cut off level of 17.8 pg/ml, with 75% sensitivity and 73.86% specificity, with area under the curve = 0.66, however, IP-10 had no statistical significance in detecting advanced fibrosis. IP-10 might be of significance as a noninvasive predictor of liver cirrhosis. IP-10 significant decline post-DAAs treatment in chronic HCV genotype IV infected patients reflects significant improvement in fibrosis stage and hepatic necro-inflammation in response to treatment. No significant correlation was detected in the changes of both IP-10 and LSM.

MicroRNA-15a expression level and its target “c-Myb” expression in Hepatocellular carcinoma Among Chronic HCV Egyptian Patients

MicroRNA-15a expression level and its target “c-Myb” expression in Hepatocellular carcinoma Among Chronic HCV Egyptian Patients

The Gamma-glutamyl Transpeptidase to Platelet Ratio (GPR) Predict Significant Liver Fibrosis and Cirrhosis in Chronic Egyptian HCV Patients

Background and aim: Non- invasive parameters of liver fibrosis are being widely incorporated and adopted in clinical practice, of them, 2 ratios APRI and FIB-4 were proposed and applied. The gamma-glutamyl transferase -to- platelet ratio (GPR) was developed and investigated as available test that is useful in predicting liver fibrosis stages in chronic HBV patients. We aimed to estimate the diagnostic performance of GPR compared to APRI in assessing different fibrosis stages estimated by ultrasound based Transient Elastography in chronic HCV Egyptian patients. Methods: This prospective study was conducted on 90 treatment-naive chronic HCV patients. Fibrosis stages were assessed by Transient Elastography. Serum aspartate transferase, alanine transferase, gamma-glutamyl transferase and platelets were estimated. APRI and GPR formulas were calculated. Results: GPR was significantly different with fibrosis stage (p value F3) from non-significant fibrosis (< F3) was significant with GPR AUC was 0.97 while APRI AUC was 0.86. GPR at cutoff point 0.31 has sensitivity 92 %, specificity 88%, PPV 86 % and NPV 91 %. While, APRI at cutoff 0.26 has sensitivity 81 % and specificity 78 %. Conclusion: The GPR represents a simple, non-invasive, inexpensive model for assessment of liver fibrosis. The GPR is a more accurate model than APRI to stage liver fibrosis in chronic HCV patients in Egypt.

Role of Ribavirin in the Era of Direct–Acting Antiviral Therapies of Chronic Hepatitis C

ABSTRACT Background The efficacy of adding ribavirin (RBV) to direct antivirals (DAAs) in HCV treatment is still debatable, with allegations of insecure profiles. Objectives To evaluate safety and efficacy of RBV in the era of DAAs in chronic HCV Egyptian patients. Methods In this cohort retrospective study, data of 847 HCV patients treated with different regimens of DAAs with or without RBV were recruited between June 2017 and September 2018. Cases were categorized into five groups: non-cirrhotic (318), compensated (196), decompensated liver cirrhosis (53), post liver transplantation (30), and 250 treatment experienced patients. All patients’ demographics and laboratory characteristics were evaluated at baseline, week4, 12, 24 of treatment. Ribavirin was prescribed or banned outside international guideline recommendations of HCV treatment in cases assembled from the private sector.Results: No statistically significant difference between RBV and non-RBV treated patients was documented regarding SVR12 (97.2%, 97.8%) respectively in the whole cohort (p 0.509). On grouping, adding RBV was only significant in the treatment experienced patients (96.8%, 85% in RBV and non-RBV regimens respectively) (p 0.001). Adding RBV to DAA regimens was generally associated with modest adverse events particularly anemia (8.5%), and hepatic decompensation (jaundice and ascites) (0.3%). Bilirubin, INR, and platelet counts all were found to be the most independent predictors of SVR achievement by multivariate analysis (p ≤ 0.05).Conclusion: RBV may still have an augmenting role in treatment experienced patients; permitting effectual shortening of therapy particularly in patients with cirrhosis, with modest side and adverse consequences.

Epithelial-mesenchymal transition of hepatocytes in chronic HCV Egyptian patients

Epithelial-mesenchymal transition of hepatocytes in chronic HCV Egyptian patients

Assessment of Liver Fibrosis Using Real Time Elastography and FIB 4 Score in Comparison to Liver Biopsy in Chronic HCV Egyptian Patients

Background: HCV is one of the etiologies causing liver fibrosis through direct deposition of extracellular matrix in the liver as a response to wound healing to compensate for the injury Aim of this study: Assessment of liver fibrosis using sonography-based real time elastography (RTE) and FIB 4 score in comparison to liver biopsy for assessment of the stage of liver fibrosis in chronic Egyptian HCV patients. Patients and methods:116 patients with HCV were enrolled in the study from 2014-2015 in the National Hepatology and Tropical Medicine Research Institute Outpatient Clinics, Cairo, Egypt. Results: The mean RTELFI of the studied group was 2.68 ± 0.74. The correlation between different fibrosis stages, FIB-4 and RTELFI showed significant relations between the degree of hepatic fibrosis and FIB-4 with p = 0.001 & RTELFI with p < 0.001. Positive correlation was detected between fibrosis stage, FIB-4 and RTELFI. At a cutoff value of 3.26 for RTELFI, the test had a sensitivity of 72% and a specificity of 90% in detecting advanced fibrosis with AUC = 0.791 (95% confidence interval 0.649-0.933). At a cutoff value of 2.26 for FIB-4 index, the test had a sensitivity of 50% and a specificity of 87% in detecting advanced fibrosis with AUC = 0.797 (95% confidence interval 0.683-0.911). Conclusion: RTE has excellent accuracy for F4 and F ≥ 3 and is superior to FIB-4.

TM6SF2 and NCAN polymorphism impact on HCV in North African Egyptian patients

Background: TM6SF2 and NCAN are genes known to be related to fibrosis and steatosis but are not thoroughly investigated in the case of chronic Hepatitis C (HCV) in Egyptians. Aim: This study is carried to investigate the role of TM6SF2 and NCAN in chronic HCV Egyptian patients. Methods: This retrospective study was carried out on 165 patients with chronic HCV who received treatment for it. Results: TM6SF2 showed statistical significance with viral load with a p-value of 0.02 but no statistical significance with fibrosis or activity. NCAN showed statistical significance with activity with a p-value of 0.011. Conclusion: this is the first work recording the prevalence of TM6SF2 (rs58542926) and NCAN (rs2228603) polymorphism in upper African HCV patients. TM6SF2 is not associated with fibrosis or activity in Egyptian patients infected with chronic hepatitis C but associated with high viral load. On the other side, NCAN is associated with severity of activity in the same studied group but no relation with the viral load. These results explain their additive effect exerted during HCV infection which should be further extensively studied.

Liver Stiffness Predicts Relapse after Direct Acting Antiviral Therapy Against Chronic Hepatitis C Virus Infection

AbstractBackground: Assessment of fibrosis in chronic hepatitis has always been considered of utmost relevance for patient care in clinical hepatology. Over the last years, multiple non-invasive methods were used for diagnosis of hepaic fibrosis, including transient Elastography in addition to clinical and biochemical parameters or combinations of both methods. Serum markers and elastography are considered useful tech-niques for diagnosing severe liver fibrosis and cirrhosis and for excluding significant fibrosis in hepatitis C virus infected patients. Also, liver stiffness may help to foretell treatment response to antiviral therapy.Aim of Study: This study aimed to evaluate changes of Transient elastography values as well as serum fibronectin and AST to platelet ratio index in patients (APRI) treated with sofosbuvir-based treatment regimen.Methods: This is a follow-up study including 100 chronic HCV Egyptian patients treated with Sofosbuvir-based treatment regimen. Transient elastography values were recorded as well as serum fibronectin and APRI were calculated at baseline and SVR12.Results: There was a significant improvement of platelets counts, ALT and AST levels, which in turn cause significant improvement in APRI scores at SVR12. Liver stiffness meas-urements were significantly lower at SVR12 (15.40±8.96 vs. 8.82±4.74 kPa, p=0.000). There was significant decline in serum fibronectin from baseline to SVR 12 (524.14±237.61 vs. 287.48±137.67, p=0.000).

Ghrelin gene polymorphism as a genetic biomarker for prediction of therapy induced clearance in Egyptian chronic HCV patients

Ghrelin (GHRL) has important implications for liver disease. It has anti-inflammatory effects, regulates cell proliferation, modulates the fibrogenic response and protects liver tissue. Genetic variations in the GHRL gene may play a crucial role in the development of chronic hepatitis (CH), liver cirrhosis (LC) and hepatocellular carcinoma (HCC). Therefore, we examined the association of GHRL gene polymorphisms (rs26312 and rs27647), and its serum level to virologic responses to combined sofosbuvir and Simeprevir therapy for a course of 12 successive weeks in Egyptian chronic hepatitis C (CHC) patients. METHODS: Human genomic and clinical data were collected from 100 Egyptian participants in this study, 90 HCV patients who received sofosbuvir and Simeprevir and 10 non-HCV healthy subjects. Genotyping of GHRL rs26312 and rs27647, were determined with the TaqMan qRT-PCR allele detection assay. The serum GHRL concentrations were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: GHRL polymorphisms (rs26312 and rs27647) genotype distributions and allele frequencies did not differ between HCV patients and normal healthy subjects or between patient groups when compared according to the therapeutic response. In addition, we found significant lower serum GHRL levels in CHC patients compared with the healthy controls. However, there was no significant association of the GHRL rs26312 and rs27647 polymorphisms with GHRL levels in CHC patients. We conclude that GHRL SNPs (rs26312 and rs27647) do not affect response to combined sofosbuvir and Simeprevir treatment in chronic Egyptian HCV patients.