Hepatitis C Virus Negative Patients Research Articles

Association between hepatitis C virus genotype 4 and renal cell carcinoma: Molecular and virological studies.

Hepatitis C virus (HCV) is the most common infection worldwide. The correlation between HCV and renal cell carcinoma (RCC) is still mysterious. Therefore, the relationship between HCV and RCC was investigated. The study included 100 patients with RCC; 32 with HCV infection, and 68 without HCV infection. Expressions of viral proteins (NS3 and NS5A) were tested using an immune electron-microscope (IEM) and immunohistochemistry (IHC). IHC and quantitative real time-PCR investigated the presentation of human proteins TP53 and p21 genes. Transmission electron (TEM) detected viral-like particles in infected RCC tissues. The gene and protein expression of P53 was higher in HCV positive versus HCV negative patients and p21 was lower in HCV positive versus HCV negative in both tumor and normal tissue samples. Viral like particles were observed by TEM in the infected tumor and normal portion of the RCC tissues and the plasma samples. The IEM showed the depositions of NS3 and NS5A in infected renal tissues, while in noninfected samples, were not observed. The study hypothesizes that a correlation between HCV and RCC could exist through successfully detecting HCV-like particles, HCV proteins, and (p53 and p21) in RCC-infected patients.

The relation between hepatitis C viral infection and follicular lymphoma clinical course and outcome in a single-center study

Background Hepatitis C virus (HCV) infection has been related in the etiology of many lymphomas. Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma. This comparative retrospective study aimed to identify a relationship between HCV and FL clinicopathologic features and neoplasm outcome. Patients and methods This study was conducted on 103 patients with FL who attended our institution during 2008–2019. Results The prevalence of patients with HCV FL was 49.5% and showed significant B symptoms (P=0.023), advanced stages (P=0.016) with higher Follicular Lymphoma International Prognostic Index scores (P=0.042). Progression-free survival showed no differences regarding the viral infection or histological grades. Median overall survival showed significant improvement with histological grades 1–2 (P<0.0001), low Follicular Lymphoma International Prognostic Index, and HCV negative patients with FL, especially in the younger subgroup. Conclusion HCV positive patients with FL had a significantly more aggressive clinicopathological presentation and shorter overall survival. Thus, early virology screening and eradication of HCV infection in FL patients may improve the neoplasm course.

Hepatitis C Prevalence, HCV awareness and Certain Psychological Factors in Patients with Opioid Use Disorder.

The objective of this study is to determine the prevalance of Hepatitis C Virus (HCV) in patients with Opioid Use Disorder and to investigate both the sociodemographic and psychological differences between patients with or without Hepatitis C Virus. Blood samples were taken from patients diagnosed with Opioid Use Disorder (OUD) who applied to Mersin Provincial Health Directorate Toros State Hospital Alcohol and Drug Addiction Treatment Center (AMATEM) between 01.09.2019-01.09.2020 and hepatitis virus markers, complete blood count and basic biochemistry were assessed. Sociodemographic Evaluation Form, Barratt Impulsivity Scale, Childhood Traumas Scale, Drug Use Disorders Identification Test (DUDIT), Temps-A Temperament Scale, Difficulty in Emotion Regulation Scale were applied to 107 patients with HCV and 101 patients without HCV who were selected by systematic sampling and the findings obtained were compared. Of the 1190 patients diagnosed with Opioid Use Disorder, 340 (28.5%) were found to be HCV positive. 107 HCV-positive and 101 HCVnegative patients who were selected for comparison were similar in terms of sociodemographic characteristics. Among HCV positive patients, the rate of intravenous drug use and needle sharing were significantly higher (p<0.001, p<0.001). Overall duration of substance use and intravenous substance use were significantly higher in HCV positive patients (p=0.024 and p=0.017). Similarly, HCV positive group were significantly more likely (p<0.001) to have heard of HCV before and significantly more likely (p=0.009) to know that HCV causes cirrhosis and liver cancer. Regarding the scores of Barratt Impulsivity Scale, Childhood Traumas Scale, Substance Use Disorder Recognition Test, DUDIT, Temps -A Temperament Scales applied to HCV positive and HCV negative patients with Opioid Use Disorder, no difference was found. The scores of the 'Non-Acceptance' factor of the Difficulties in Emotion Regulation Scale were found to be significantly higher in HCV positive patients with Opioid Use Disorder (p=0.020). Patients diagnosed with Opioid Use Disorder (OUD) have higher rates of HCV positivity compared to general public. Intravenous drug use significantly increases this risk. Half of HCV-positive patients were unaware that they have the virus and only a very small proportion received treatment. Therefore, examining each patient with OUD for HCV, treating positive patients in an effective referral system seems to be the an important step in the eradication of this disease in this population.

Outcomes and Risk Factors for Complications in Cataract Patients with Hepatitis C Virus Infection

ABSTRACT Purpose To describe outcomes of patients with hepatitis C virus (HCV) seropositivity undergoing cataract surgery, as well as investigate risk factors for surgical complications. Methods This is a retrospective cohort study of all consecutive patients who underwent cataract surgery at a tertiary care hospital in the United States between 2014 and 2019. The exposure of interest was HCV seropositivity and outcomes included surgical complications and associated risk factors, visual acuity, and post-operative complications. Results A total of 11,276 eyes of 6,858 patients were included in the study, of which 122 patients (1.78%) and 210 eyes (1.86%) were HCV positive. Average age at surgery was 63.4 (8.4) years for HCV positive patients and 69.1 (10.6) years for HCV negative patients. Patients with HCV were more likely to suffer a complication during cataract surgery, 2.9% versus 1.2% (OR 2.27, 95% CI 1.03 to 5.01, p = .0415). Postoperative best corrected visual acuity was excellent: median and range 0.00 (−0.13, 3.00) logMAR for HCV positive eyes versus 0.00 (−0.30, 3.00) logMAR for HCV negative eyes. Among HCV positive patients, elevated alanine transaminase (>52 U/L) was associated with a higher intraoperative complication rate (10.0% vs 1.8%, OR 5.53, 95% CI 1.05 to 29.2, p = .044). Conclusion While patients with HCV are more likely to have complications during cataract surgery, final best corrected visual acuity was excellent regardless of HCV status. Patients with HCV are more likely to undergo cataract surgery at a younger age, and those with elevated alanine transaminase are at highest risk for complications.

Association of Type 2 Diabetes Mellitus with Chronic Hepatitis C Virus Infection

Objective: To determine the association of type 2 diabetes mellitus with chronic hepatitis C virus (HCV) infection.&#x0D; Study Design: Case control study.&#x0D; Place and Duration of Study: Combined Military Hospital, Peshawar Pakistan, from Jun 2017 to Jun 2018.&#x0D; Methodology: After fulfilling the inclusion criteria, 190 patients were enrolled in the study and divided into two equal groups. The patients of either gender with positive anti-hepatitis C antibodies/PCR for HCV, ribonucleic acid (RNA) were included as cases and apparently healthy individuals reporting for blood donation were included as controls. Plasma glucose was tested by hexokinase enzymatic method using Advia 1800 after 8 hours fast. Then the association between the two major diseases was observed.&#x0D; Results: Patients in the case and control groups had the mean age of 40.26 ± 8.05 and 40.29 ± 8.89 years respectively whereas body mass index in the case group was 26.60 ± 1.67 kg/m2 and 26.05 ± 1.49 kg/m2 in the control group. Mean duration of HCV infection was 7.03 ± 2.21 months in the case group. Mean serum ALT level was 46.81 ± 7.25 U/L in the case group and 28.43 ± 4.66 U/L in the control group. A total of 76.8% of patients in case group had been treated for HCV infection previously. Type 2 diabetes was seen in 38 (40%) cases and 19 (20%) controls (Odd Ratio=2.60; p=0.002).&#x0D; Conclusion: Type 2 diabetes mellitus is more frequent amongst HCV positive patients as compared to HCV negative patients.

New markers of oxidative stress in lichen planus and the influence of hepatitis C virus infection – a pilot study

Abstract Introduction. Lichen planus (LP) is a mucocutaneous T-cell mediated disorder of unknown etiology. There is growing evidence that oxidative stress is an important player in the pathogenesis of LP. Therefore, we have investigated oxidative stress markers in LP and the influence of hepatitis C virus (HCV) infection, a frequently associated condition, on oxidative stress in LP patients. Method. We have determined the serum levels of 4- hydroxynonenal (4-HNE) and symmetric dimethylarginine (SDMA), as markers of oxidative stress, and total antioxidant capacity (TAC), as a marker of the antioxidant defence, in 4 groups: group A – HCV positive patients with LP (n=12), group B – HCV positive patients without LP (n=12), group C – HCV negative patients with LP (n=31) and group D – control group (n=26). Results. In LP patients, we have identified an increased level of lipid peroxidation (4-HNE – group A – 8.41±1.11 μg/mL, group B - 7.97±2.17 μg/mL, group C – 7.81±1.96 μg/mL and group D – 6.15±1.17 μg/mL) and alterations in arginine methylation (SDMA – group A – 1.10±0.24 μmol/L, group B – 1.03±0.16 μmol/L, group C – 0.84±0.19 μmol/L and group D – 0.50±0.06 μmol/L) associated with a diminished antioxidant defence (TAC – group A – 234.50±49.96, μmol/L group B – 255.83±41.41 μmol/L, group C – 269.83±43.33 μmol/L and group D – 316.46 ±29.33 μmol/L), processes augmented by the association with HCV infection. Conclusion. There is an imbalance between oxidants and antioxidants in patients with LP, an imbalance that is augmented by the presence of HCV infection. SDMA could be regarded as a novel biomarker of oxidative stress among these patients. To the best of our knowledge this is the first study to investigate the influence of HCV infection on oxidative stress in LP patients.

Retrospective study to assess the impact of hepatitis C virus infection on the prognosis and management of multiple myeloma.

e20001 Background: Multiple Myeloma (MM) is a neoplasm of the post-germinal center, terminally differentiated B-cells. MM accounts for 1% of all types of cancer and 10% for all hematologic malignancies. Chronic hepatitis C virus (HCV) is an infection that affects over 71 million patients worldwide. Cytotoxic agents and immunosuppressive therapy as steroids are the main line of therapy in lymphoid malignancies, but these drugs may exacerbate chronic viral hepatitis and cause uncontrolled replication of hepatitis viruses. The impact of HCV infection on MM patients remains unclear. Objective: To assess the impact of HCV infection on the prognosis and management of MM patients. Methods: A 10-year retrospective study of MM patients was conducted at Cairo University Clinical Oncology Department from January 2009 to April 2019. Results: During this time, 150 patients were diagnosed with MM, 109 (72.7%) were HCV negative, 24 (16%) were HCV positive, and 17 (11.3%) with unknown HCV status. The median age was 51 and 54 years for HCV negative and positive groups respectively, with a statistically insignificant difference (p-value &gt; 0.2). In the multivariate analysis, HCV infection was not an independent factor related to overall survival (OS), however age, creatinine and hemoglobin levels correlated significantly with OS (p &lt; 0.009, 0.008, 0.031 respectively). The median OS for the HCV negative group was 31.11 months (95% CI: 22.62 - 39.61) compared to 37.66 months (95% CI: 7.19 - 68.13) for the HCV positive group. The median progression-free survival (PFS) for all patients was 18.9 months, for HCV positive patients was 15.36 months (95% CI: 13.18 – 17.54), and for HCV negative patients was 20.49 months (95% CI: 14.13 – 26.85). Age below 60 years and creatinine level less than 2 mg/dL were statistically significant for favorable disease-free survival (DFS) (p &lt; 0.030, 0.034 respectively). Conclusions: Age, creatinine and hemoglobin levels are significant prognostic factors in MM but HCV status doesn’t affect the overall survival or progression-free survival. HCV infection should not contraindicate MM therapy.

S3511 Management of Complications After Liver Transplantation for Hepatitis C Negative Patients Receiving Hepatitis C Positive Organs

INTRODUCTION: More than 16,000 patients are awaiting a liver transplant with less than 6,700 successful liver transplants in the U.S. that occur each year. Using a hepatitis C virus (HCV) positive donor liver for transplantation increases the donor pool. When HCV negative patients receive an HCV positive liver, they are at risk of acquiring HCV infection. We report two cases of patients who were HCV negative and received HCV positive donor liver subsequently acquiring HCV infection and developing associated complications. CASE DESCRIPTION/METHODS: The first patient is a 71 year old male with a history of non-alcoholic steatohepatitis (NASH) cirrhosis, hepatocellular carcinoma, and hepatic encephalopathy. He developed HCV infection status-post orthotopic liver transplantation from HCV donor. Imaging before transplant and explant pathology showed hepatocellular carcinoma. He was found to have HCV genotype 2B infection 2 weeks post-transplant as part of protocol testing. He was treated with sofosbuvir/velpatasvir for 12 weeks and achieved sustained viral response (SVR). Imaging at 5 months post-op revealed 2 hypovascular masses diagnosed as epstein barr virus associated B-cell post-transplant lymphoproliferative disorder (PTLD). Treatment was initiated with rituximab and his hospital course was complicated by bacteremia and atrial fibrillation. The second patient is a 52 year old male with NASH cirrhosis status-post orthotopic HCV positive liver transplant. His post-transplant course was complicated by elevated liver enzymes and renal insufficiency. He was found to have HCV genotype 1a, 3 months after transplant, and was treated with sofosbuvir/velpatasvir for 12 weeks with achieving SVR. Liver tests subsequently returned to normal with treatment. DISCUSSION: Although using HCV positive donor liver increases the donor pool it is associated with increased risk of HCV transmission to the recipient. These recipients need to be closely monitored so they could be treated in a timely manner to prevent any associated complications.Figure 1.: CT scan showing two hypovascular hepatic masses in the right and left lobes, measuring up to 3 cm.

Customized hepatocellular carcinoma prediction panel

Abstract Background West Africa is a hotbed of hepatocellular carcinoma (HCC) partly due to aflatoxin B (AFB) contamination. In Russia, there is now a pool of patients who have liver cirrhosis due to hepatitis C virus (HCV), who were treated with direct antiviral agents and HCV negative, but due to cirrhosis are in the risk group for HCC development. MiRNAs are candidate molecules for HCC prediction panel. The question is if it is possible to use the same miRNAs for HCC development risk despite background or it is reasonable to have a special miRNA set according to background (for example, HCC, HBV, continuous AFB consumption etc.). Methods Samples from Somalia: 40 plasmas of HCV negative patients with HCC, 8 plasmas of HCV positive patients with HCC, 22 plasmas of HCV-negative patients with liver cirrhosis, 8 plasmas of HCV-positive patients with liver cirrhosis, 11 plasmas from healthy students living outside West Africa last 9-12 months as control group. Samples from Russia: 12 plasmas of patients with HCC (HCV+ and HCV-) and 30 plasmas of patients with liver cirrhosis, 11 plasmas from healthy donors as control group. Exosomes were isolated from plasma by differential ultracentrifugation following free-flow electrophoresis. MiRNA let-7a-5p, -224-5p, -106b-3p, -126-5p, -122-5p, -16-5p and -34a-5p were determined in exosomes by qPCR-RT. Same free miRNA from plasma were determined. Plasma samples were examined for AFB1. Results There is an interesting tendency for miRNA-21 and mi-RNA-122: on the stage of cirrhosis in Somalian samples there is a significant difference in expression levels that disappears on the HCC stage. Profiles of free miRNAs circulating in plasma were not significantly different between the groups. There was a difference in exosomal miRNA profile of plasma from patients with HCC and cirrhosis for both (Russia and Somalia) group of samples. Conclusions The difference in miRNA profiles of HCC patients on the background of HCV or aflatoxins consumption may allow supposing different epigenetics dysregulation happening in HCC depending on the trigger factor. According to our results, exosomal miRNA identification in HCC patients seem to be more accurate than plasma free miRNAs and it seems reasonable to modify biomarker panel for HCC risk according to the case background it is intended to work for. Legal entity responsible for the study The authors. Funding Ministry of Science and Higher Education of the Russian Federation Project 5-100. Disclosure All authors have declared no conflicts of interest.

Sentinel biomarkers in HCV positive patients with mixed cryoglobulinemia

BackgroundInfections, autoimmunity and cancer play a role as determinants of etiology in Hepatitis C virus (HCV) related mixed cryoglobulinemia (MC). Several factors of risk have been suggested as markers of pathogenesis and progression of HCV-related MC into B cell Non-Hodgkin's Lymphoma (B-NHL). Here, we evaluated IgG subclass distribution, free light chains (FLCs) and vascular endothelial growth factor (VEGF) as a new combination of biomarkers. MethodsWe measured IgG1–4 subclasses, FLCs and VEGF levels in sera 53 from HCV-related MC, in comparison with 40 sera from HCV negative patients with rheumatoid arthritis (RA) and 30 from healthy blood donors (HBD). ResultsIgG3 levels were significantly higher in HCV-MC patients with a decrement of IgG2 and IgG4; FLC levels significantly increased in both MC and RA patients' groups; serological VEGF was higher in HCV-MC patients than in HBD in correlation with k and λ levels. ConclusionOur results suggest that a specific IgG subclasses pattern together with raised levels of FLCs and VEGF could represent the biomarker “signature” of an inflammation multistage of acquired immune system.

Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia.

Anecdotal reports have suggested that transplantation of hepatitis C virus (HCV) antibody positive (Ab+)/nucleic acid test negative (NAT-) donor kidneys into HCV negative recipients is not associated with HCV transmission. We reviewed our center's outcomes of 32 HCV negative patients who received kidney allografts from 25 donors who were HCV Ab+/NAT-. The mean recipient age was 56.9±12.1years and the mean donor age was 41.5±14years, with a median Kidney Donor Profile Index (KDPI) of 68%. Twelve donors (48%) met Public Health Service (PHS) increased risk status. All patients received antithymocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and steroid maintenance immunosuppression. With a mean follow-up posttransplant of 10±2.7months, 1- and 3- month serum creatinine levels were 1.7±0.8 and 1.3±0.4, respectively, and patient and graft survival rates were 100% and 97%, respectively. Fourteen patients (44%) seroconverted and became HCV Ab+ posttransplant. However, all 32 patients were HCV RNA negative at 1- and 3- months posttransplant, and 27 and 8 patients tested at 6- and 12-months posttransplant, respectively, remain HCV RNA negative. In conclusion, transplantation of HCV Ab+/NAT- kidneys to HCV negative recipients frequently causes HCV Ab seroconversion but not HCV viremia.

Value of toll-like receptor 3 (TLR3) in chronic kidney disease patients with hepatitis C virus infection

Background Hepatitis C virus (HCV) infection is a severe public health problem with a worldwide predominance of 3%. An estimated 5–20% of infected patients develop cirrhosis annually, and 1–4% of them develop hepatocellular carcinoma. In Egypt, the prevalence of HCV antibody and HCV RNA are 10.0 and 7.0%, respectively, in the 15–59 years age group. In children of 1–14 years old, the prevalence of HCV antibody and HCV RNA are 0.4 and 0.2%, respectively. HCV infection is a cause of chronic kidney disease (CKD) and results in a significant problem in hemodialysis (HD) patients. Toll-like receptors (TLRs) might have an essential role in the pathogenesis of renal diseases. They include TLR1, TLR2, TLR3, TLR4, TLR5, TLR6, TLR7, TLR8, TLR9, TLR10, TLR11, TLR12, and TLR13, though the latter two are not found in humans. Recently, it is shown that the mouse and human kidney tubular epithelial cells appear to express TLR3 constitutively and upregulate its expression upon challenge with its legend. For this reason, it appears conceivable that this receptor might play an essential role in this organ in health and disease. Aim The present study was carried out to determine the value of TLR3 in CKD patients with HCV infection. Also, we aimed to study the levels of TLR3 for Child–Pugh different classes to determine its impact on the prognosis of liver disease in those patients. Patients and methods All participants were selected from the National Institute of Urology and Nephrology. Their ages ranged between 40 and 62 years. Our study included 130 individuals of which 105 patients were selected from a dialysis unit with the end-stage renal disease on regular HD three times/week for at least 1 year and 25 healthy participants as a control group. They were divided into three groups. The control group (GI) consisted of 25 clinically healthy participants matched for age and sex; GII constituted 45 HCV negative patients; and GIII had 60 HCV positive patients. GIII was subclassified into GIIIA, GIIIB, and GIIIC, each of which consisted of 20 patients according to the Child–Pugh scoring. All patients and control samples were subjected to the following tests: Antibody screening for HCV using the ELISA technique and quantitative HCV RNA by PCR. Detection of TLR3 was done using the ELISA technique. Other parameters such as Complete Blood Picture (CBC), Prothrombin Time (PT) (INR), urea, creatinine, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), total bilirubin, alkaline phosphatase, albumin, cholesterol, and triglycerides levels were also estimated. Results The percentage of HCV-positive cases among a studied group of patients on HD was 57.2%, and the percentage of negative cases was 42.8%. There was no significant difference between GI, GII, and GIII as regards age and duration of dialysis. There was a highly significant difference between GIII as regards TLR3, INR, urea, total bilirubin, albumin, and triglycerides compared with GI and GII. There was a highly significant positive correlation of TRL3 with creatinine and PCR RNA and a significant negative correlation with albumin and cholesterol. We also found that there was a highly significant difference between GIIIC as regards INR, total bilirubin, and albumin compared with GIIIA and GIIIB. TLR3 showed no significant difference between GIIIA, GIIIB, and GIIIC. Conclusion TLR3 may have a role in the pathogenesis of HCV infection-related CKD and can be used as a new marker for the development of HCV related end-stage renal disease.

Impact of Chronic HCV Infection on Coronary Calcification in Prevalent Haemodialysis Patients

Background: Hepatitis C virus (HCV) chronically infects an estimated 170 million people worldwide. Approximately 30% of patients who develop acute hepatitis C recover spontaneously, signaled by improved symptoms, normalized liver-related chemistries, loss of HCV RNA from serum, and the development of HCV antibody. Cirrhosis rates become significant after 20 years of HCV infection. Haemodialysis is a process that uses a man-made membrane (dialyzer) to clear wastes such as urea from the blood, restore the proper balance of electrolytes in the blood and eliminate extra fluid from the body. Vascular calcification is common in patients with advanced haemodialysis and is associated with poorer outcomes. Objectives: The aim was to evaluate the possible impact of chronic HCV infection on coronary calcification in prevalent haemodialysis patients in Naval Forces hospital, Alexandria, Egypt and its relation to demographic data, haemodialysis data and other laboratory findings. Patietns and methods: This cross-sectional study was carried out on 60 patients with at least one year duration on regular haemodialysis; 30 HCV negative prevalent haemodialysis patients and 30 HCV positive prevalent haemodialysis patients. Results: Our study revealed that HCV negative patients included 25 (83.3%) males and 5 (16.7%) females, their mean age was 51.67 ± 6.91 years. The mean haemodialysis duration was 7.5 ± 1.89 years. There were statistically a high significant difference between HCV negative prevalent haemodialysis patients and HCV positive prevalent haemodialysis patients regarding AST, significant differences regarding ALT and albumin and non-significant differences regarding bilirubin, prothrombin time, international normalized ratio, cholesterol and total glycerides. But, there were no significant differences between HCV negative prevalent haemodialysis patients and HCV positive prevalent haemodialysis patients regarding CKD-MBD parameters (including PO4 and iPTH), except for calcium which exhibited statistically a significant difference. Also, there were no significant differences between HCV negative prevalent haemodialysis patients and HCV positive prevalent haemodialysis patients regarding creatinine, sodium and potassium, significant differences regarding URR, C-reactive protein and a high significant difference regarding Ca score. In HCV negative prevalent haemodialysis patients, there were statistically significant correlations regarding dialysis duration and international normalized ratio and high significant correlations between Ca score and creatinine, AST and prothrombin time. In HCV positive prevalent haemodialysis patients, there were statistically significant correlations between Ca score and dialysis duration and creatinine. Other correlations were insignificant. There were non-significant relations between Ca score and gender and dialysis vascular access. Conclusion: A very high incidence of vascular calcification was found in chronic haemodialysis patients in our study as compared to other studies. Vascular calcification is correlated with many risk factors and control of the modifiable risk factors can help to decrease prevalence of vascular calcification.

Seroprevalence of Anti-HCV Antibody in Patients with Chronic Kidney Disease before Starting Dialysis Therapy

Background: Hepatitis C virus (HCV) infection and chronic kidney disease are common and potentially serious medical problems throughout the world. In recent years, it has become clear that these two conditions are linked in several important ways. Indeed, some forms of renal diseases are precipitated by HCV infection and patients with end-stage renal disease (ESRD) are at increased risk for acquiring HCV infection. Patients with chronic kidney disease typically show an impaired immune response compared with healthy individuals and also other risk factors related with treatment and management. CKD patients ultimately undergo end stage renal therapy like dialysis for their treatment and survival. Risk factors for the infections are more in dialysis period than in predialytic stages. Like other developing countries CKD patients with HCV infection are very common in our country. For this reason the CKD patients should be properly diagnosed knowing the infection status before dialysis which would help both the patient and doctor to choose their proper treatment approach.Objective: This cross-sectional study was done to know the prevalence of HCV infection in the CKD patients before starting dialysis therapy.Materials and Methods: A total of 197 patients with chronic kidney disease stage five (CKD-V) before starting dialysis therapy were included as subjects of this study. Among the CKD patients anti-HCV was detected to see prevalence of hepatitis C virus infection. The patients were also tested for HBsAg to assess co-infection. After collecting all the data of different test results analyses were done by SPSS version 15.0.Results: In this study 195 (99%) patients were anti-HCV negative and only two patients (1%) were found positive.Conclusion: HCV infection in CKD patients before dialysis should be taken into account so that HCV negative CKD patients would not get the infection during dialysis and standard screening procedures should be taken to prevent transmission of infection.J Enam Med Col 2017; 7(1): 20-24

The Diagnostic and Prognostic Impact of Serum miRNA-21 in a Sample of Hepatitis C/None Hepatitis Diffuse Large B Cell Lymphoma Egyptian Patients

Background: Circulating microRNAs are potential biomarkers of diagnostic and prognostic impact in various inflammatory and malignant diseases. Aim: Linking inflammation with malignancy, we studied miRNA-21 in sera of hepatitis-C-virus (HCV) and none hepatitis diffuse large B-cell lymphoma (DLBCL) patients, aiming to identify its differential expression and prognosis in DLBCL with its subtypes; germinal center B-cell (GCB) and activated B-cell-like (ABC) and to evaluate its relation with HCV. Subjects and Methods: MiRNA-21 expression was measured using TaqMan quantitative RT-PCR in sera of 30 newly diagnosed DLBCL patients (HCV positive (n = 10), HCV negative (n = 20)) and 20 controls (HCV positive (n = 10), HCV negative (n = 10)). Results: MiRNA-21 expression was significantly higher in DLBCL patients than in control (p = 0.00). Significant positive correlations between miRNA-21 and LDH, IPI and disease stage were detected (p < 0.05). Significantly higher miRNA-21 was detected in ABC sub-type compared to GCB sub-type (p = 0.00). Higher miRNA-21 was associated with worse response (p = 0.016), 2 years overall (p = 0.017) and progression free survival with statistical significance (p= 0.003). Significantly higher miRNA-21 levels were detected in HCV positive DLBCL patients compared to HCV negative patients (p = 0.00). Higher miRNA-21 levels were detected in HCV positive ABC subtype than GCB subtype (p = 0.05). Significantly higher levels were also detected in HCV positive controls compared to HCV negative controls. Conclusion: Our study shows that miRNA-21 is over expressed in our patients with DLBCL, displaying higher levels in ABC than in GCB subtypes. MiRNA-21 is associated with poor response to treatment and survival in DLBCL. MiRNA-21 is a potential marker of necro-inflammation independent of its role in tumorogenesis, showing higher expression in HCV positive DLBCL patients compared to none hepatitis patients.

Hepatitis C and Baby Boomers: Efficient Utilization of Resources

Introduction: Hepatitis C Virus (HCV) infection is a silent epidemic currently affecting 3.5 to 5 million people in the US. With the advent of new direct acting antivirals (DAA) an aggressive screening and treatment approach is imperative. According to the guidelines all baby boomers should be screened. We hypothesized that universal screening of baby boomers without any risk factors may be an unnecessary burden and hence conducted this study. Methods: A retrospective chart review of all the baby boomers presented in between January 2010-October 2015 was performed. Information collected included the age, sex, race, HCV serology, genotype, alcohol consumption and HCV risk factors. The prevalence and risk factors stratification was performed and data was analyzed to particularly assess the prevalence of HCV with respect to their risk factors. The patients who were HCV positive but denied any risk factors were interviewed again about the presence of risk factors. Results: A total of 573 charts were reviewed. Prevalence of HCV was 26.8% (154/573 patients) with 59% males and 41% females. A total of 132 HCV infected patients were risk stratified as 22 patients were lost to follow up. Almost all (99.2 %) HCV infected population reported exposure to one of the risk factors, most common risk factors being intravenous drug abuse (37%), cocaine sniffing (26.5%) and blood transfusion before 1992 (19.6%). Only 1/132 HCV positive patients denied being exposed to identifiable risk factor. Majority of HCV negative patients, 85.2% (357/419) were negative for risk factors and 14.8 % patients were negative HCV but with positive risk factors. Conclusion: Complying with the CDC recommendation of universally screening baby boomers, we have faced resistance from some patients raising ethical issues. The fear and stigma of being tested for the disease that has been associated with high risk behaviors, adds to the psychological stress in the particular group of patient population. This study reinforces a striking association in between HCV infection and risk factors. Therefore, we suggest that aggressive screening of baby boomers with a risk factor questionnaire will be a more efficient practical approach rather than applying universal screening.Table 1: Risk Factor Stratification Of Baby Boomers

Prevalence of chronic hepatitis C virus (HCV) infection in patients with idiopathic pulmonary fibrosis

IntroductionPathogenic sequences leading to the development of idiopathic pulmonary fibrosis (IPF) are unclear; but one theory is that, in a genetically susceptible host, there is a “triggering agent or event inducing an inflammatory reaction in the lung that perpetuates itself and causes parenchymal fibrosis”. One potential source for a self-perpetuating triggering event could be a chronic viral infection. For this reason, evidence for an association between IPF and chronic viral infection has been sought by many investigators for several different viruses, including HCV. ObjectiveTo estimate the prevalence of chronic hepatitis C virus infection in patients with idiopathic pulmonary fibrosis via detection of HCV antibodies in selected patients in comparison to the control group. Patients and methodsIn this study we evaluated 30 patients diagnosed with idiopathic pulmonary fibrosis according to diagnostic criteria of American Thoracic Society (ATS) in comparison to 60 healthy control subjects. All enrolled subjects underwent a serologic test for HCV infection by detecting hepatitis C surface antigen (HCVsAg) by a third-generation enzyme-linked immunosorbent assay (ELISA) test. All patients had undergone dyspnea severity assessment by the mMRC score, routine laboratory testing including arterial blood gases (ABGs), pulmonary function testing (PFTs), chest-X-ray, high resolution CT scan (HRCT), liver ultrasonography and bronchoscopy (when needed). Results9 IPF patients were positive for HCV (30%), while 17 control subjects were positive for HCV (28.3%) (p=0.869). In HCV positive IPF patients there were more severe dyspnea as assessed by the mMRC score (p=0.042∗), lower FVC (p=0.011∗), SaO2% and PaO2 were significantly lower (p⩽0.001∗ for both parameters), and more severe HRCT scanning score (p=0.012∗), in comparison to HCV negative IPF patients. There was significant negative correlation between the HRCT score and FVC (p=0.011∗) in HCV positive IPF patients, there was significant negative correlation between liver cirrhosis and PaO2 (p=0.023∗), PaCO2 (p=0.002∗) in HCV positive IPF patients. ConclusionDespite the fact that we couldn’t confirm the hypothesis that HCV can be a causative agent in the development of IPF, however, we have shown that HCV can be a predisposing factor for the development of a more severe form of IPF. Therefore screening IPF patients for the presence of underlying HCV infection can have important therapeutic and prognostic implications in those patients.

Anti-CCP hs (high sensitive) in Egyptian rheumatoid arthritis patients associated with chronic hepatitis C virus infection

Aim of the workThe objectives of this study were to evaluate the use of anti-cyclic citrullinated peptide high sensitive (anti-CCP hs) in the differentiation between rheumatoid arthritis (RA) and chronic hepatitis C virus (HCV) associated arthropathy and its correlation with disease activity and the degree of liver cirrhosis in RA associated with chronic HCV infection. Patients and methodThis study was carried out on 90 chronic HCV infection patients, 90 HCV negative RA patients and 90 HCV positive RA patients, in addition to 90 healthy volunteers. Hepatic assessment, rheumatological examination, quantitative HCV RNA test and abdominal ultrasonography were assessed in all HCV patients. Disease activity score (DAS-28) was assessed in RA patients. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antinuclear antibodies (ANA), cryoglobulins, rheumatoid factor (RF), anti-CCP3, anti-CCP hs test were assessed for all patients. ResultsThe higher frequency of anti-CCP hs was found in RA (HCV+ve) (88.9%) compared to RA (HCV-ve) (75.5%) and HCV patients (14.4%), its sensitivity in RA patients was 75.6% and specificity was 85.6%. In HCV patients anti-CCP hs significantly correlated with cryoglobulinemia and scoring for liver fibrosis (p<0.001). In RA patients, anti-CCP hs significantly correlated with RF, anti-CCP3, DAS-28, ESR and CRP (p<0.001). ConclusionsSerum anti-CCP hs is sensitive but not a specific marker for RA patients and cannot be used as a diagnostic marker to differentiate between RA and chronic HCV associated arthropathy, in addition it cannot be used as a marker of activity in RA especially when associated with HCV.

Occult Hepatitis B Virus Infection among Egyptian Hepatitis C Virus Seropositive and Seronegative Hemodialysis Patients in Sohag Government , Upper Egypt

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) Infections are important and common causes of liver disease in end-stage renal failure (ESRF) in patients on haemodialysis (HD). HBV is less endemic than HCV in Egypt (ranges from 2%–7%). Although, the prevalence of HBV in haemodialysis patients has decreased significantly due to HBV vaccine and screening of blood donors, the immunosuppressive nature of renal disease often leads to chronicity of the HBV infection and an opportunity for nosocomial spread of the infection among dialysis patients. Haemodialysis patients are more risky to develop occult hepatitis B infection (OBI) due to an increased number of blood transfusions, frequent invasive procedures, difficulty in diagnosis of occult hepatitis B infection (OBI) and immunosuppression. Occult hepatitis B infection (OBI) is defined by the presence of HBV DNA in serum or liver tissue in the absence of HBsAg. Objective: to study the prevalence of occult HBV infection in HCV-positive and HCV negative patients on regular hemodialysis from Upper Egypt. Methodology: One Hundred hemodialysis patients with negative HBsAg were included in the study. These patients were divided into two groups: HCV positive and HCV negative, based on the results of anti-HCV by ELISA and HCV-RNA by PCR. HBV-DNA was studied using the real-time PCR method in both groups. Results: HBV DNA was detected in 7 of the 100 patients (7%) and HBcAb was detected in 22 patients (22%). There were no statistically significant differences in the age, sex, duration of hemodialysis, biochemical parameters, HBcAb, or HBV DNA between patients with and without HCV infection. Conclusion: The prevalence of occult HBV infection (OBI) among Egyptian hemodialysis patients is 7 % with no significant difference in the prevalence of OBI between hemodialysis patients with or without HCV infection and we suggest screening of all HD patients for OBI by testing anti-HBc and HBV DNA

Evaluation of the Antibody Response against Hepatitis C Virus Infection in Patients on Maintenance Hemodialysis (MHD): A Pilot Study

Majority of the patients with end stage renal disease (ESRD) are on maintenance hemodialysis (MHD) in Bangladesh. Dialysis patients are at high risk for contracting blood borne infection including hepatitis C virus (HCV) infection. The aim of this study was to evaluate the antibody response of hepatitis C virus infection in patients on MHD by detecting different viral markers in blood. A total of 88 patients with chronic kidney disease (CKD)were recruited from BIRDEM and BSMMU during the period from June 2006 to June 2007. Of them 63 patients on MHD and 25 predialysis patients were taken as cases and controls respectivly. Anti-HCV antibody were positive in 38% of dialysis patients but none of the controls were positive for Anti-HCV. When HCV positive MHD patients (38%) were compared to HCV negative MHD patients (62%), it showed that HCV positive patients had longer duration of dialysis (24±25 vs 9±6 months, p&lt;0.001), increased number blood transfusions (29±34 vs 10±9 units, p&lt;0.004) and elevated serum alanine aminotransferase level (35±23 vs 20±9 U/L, p=0.001). Implementing comprehensive infection control program by routine screening of the CKD patients, safe blood transfusion program, reducing transfusion of blood by use of erythropoietin and proper disinfection and cleaning of hemodialysis units may reduce the infection by HCV Virus. DOI: http://dx.doi.org/10.3329/bjmb.v7i1.18573 Bangladesh J Med Biochem 2014; 7(1): 9-13