Occult Hepatitis C Virus Infection Research Articles

Molecular Analysis and Ex Vivo Infectivity of Seronegative Occult Hepatitis C Virus: A Study in Single Haemodialysis Centre.

In occult hepatitis C virus infection (OCI), hepatitis C virus ribonucleic acid (HCV RNA) is detectable in peripheral blood mononuclear cells (PBMCs) but is not evident in serum or plasma. Understanding of OCI in patients with seronegative anti-HCV antibodies is limited. In this study, six HCV isolates from haemodialysis (HD) patients with seronegative OCI were identified by molecular assays and phylogenetic analysis. The virus infectivity was assessed ex vivo using a primary naïve PBMC culture system. HCV isolates obtained from the PBMCs of 10 patients with chronic HCV infection (CCI) were characterised concurrently and used as positive controls in the cell culture. Sequence analysis of the 5' untranslated region (UTR) and non-structural 5B (NS5B) region revealed that HCV genotype 3 was the most prevalent virus type in both the OCI and CCI groups. One of the occult HCV isolates was identified as a mixed type. The mean viral load (log10 RNA copies/106 cells) in the PBMC samples of the OCI group (M = 3.4, SD = 0.7) was lower than that of the CCI group (M = 4.6, SD = 1.7). Upon culture, de novo OCI-HCV replicates were detected in five out of six naïve PBMC cultures. Analysis of the replicates showed a single guanine addition in the domain III of 5'-UTR but the overall molecular structure was retained. Seronegative OCI is an active form of infection that replicates at a low level in PBMCs. Seronegative OCI may share the same route of transmission as CCI. The retained viral competency may have an implication for its persistence.

Unraveling IL-17 and IL-22 role in occult hepatitis C versus chronic hepatitis C virus infection

BackgroundCytokines play a crucial role in regulating the function of the immune system by controlling the production, differentiation, and activity of immune cells. Occult hepatitis C virus (OHCV) infection can lead to liver damage, including cirrhosis and hepatocellular carcinoma. This study investigates the immunopathogenic impact of the cytokines IL-17 and IL-22 in OHCV infection compared to chronic hepatitis C (CHC) infection.MethodsWe studied three groups of patients: 35 with OHCV, 100 untreated patients with CHC, and 30 healthy control subjects. All subjects underwent physical examination and biochemical testing. We used the sandwich enzyme-linked immunosorbent assay method to measure serum IL-17 and IL-22 levels in all groups.ResultsCompared to the occult and control groups, the CHC group had significantly higher serum IL-17 levels (p < 0.001). The occult group also had higher serum IL-17 levels compared to the control group (p < 0.0001). There were no significant differences in IL-22 levels across the research groups. In the OHCV group, individuals with moderate inflammation (A2-A3) had significantly higher serum IL-17 levels than those with minimal inflammation (A0-A1), while in the CHC group, this difference was not statistically significant (p = 0.601). Neither the occult nor the CHC groups showed a correlation between serum IL-22 and inflammatory activity. There was no significant correlation between the levels of IL-17 or IL-22 and the stage of fibrosis/cirrhosis in either group. ROC curves were calculated for serum IL-17 and IL-22 levels and occult HCV infection, with cut-off values set at ≤ 32.1 pg/ml and < 14.3 pg/ml for IL-17 and IL-22, respectively. The AUROC (95%CI) was significantly higher for IL-17 than IL-22 (0.829 (0.732–0.902) vs. 0.504 (0.393–0.614), p < 0.001), suggesting that IL-17 has a stronger correlation with infection risk than IL-22.ConclusionThis study suggests that IL-17 may be involved in the immunopathogenesis of OHCV infection, especially in patients with moderate inflammation.

Prevalence of Hepatitis C Virus and Its Occult Infection in Hemodialysis Patients

Background: Hepatitis C virus (HCV) is one of the most common infections in hemodialysis patients, which has been associated with increased incidence of morbidity and mortality, particularly in low- and middle-income countries. Objectives: The current study aimed to evaluate the HCV antibody, occult HCV infection (OCI), and related risk factors among hemodialysis patients. Methods: In this cross-sectional study, 100 hemodialysis patients referred to a dialysis center in Kerman between December 2021 and March 2022 were assessed for HCV, OCI, and their related risk factors. The information related to risk factors was collected by questionnaire, while HCV and OCI were detected through serology and real-time polymerase chain reaction (PCR) methods, respectively. Results: Among the patients participating in the study, 61 were men, and 39 were women. The average age was 58.1 ± 14.9 years in men and 63.6 ± 11.4 years in women. Diabetes and hypertension history, old age, low education, self-employment, and urban living were more common in chronic kidney disease patients. The enzyme-linked immunosorbent assay (ELISA) revealed 3% positive seroprevalence HCV infection, but only 1% was positive for OCI. Although no statistically significant relationship was found between the presence of HCV (antibody and OCI) and other parameters, all positive HCV cases were identified in patients with low education and freelance employment. Conclusions: Hemodialysis patients had a low prevalence of HCV antibody and OCI. Improving various factors and conditions such as lifestyle, occupation, educational level, and dialysis ward and machine disinfection could be beneficial in managing and controlling hemodialysis complications such as HCV and OCI.

Occult hepatitis C virus infection in hemodialysis patients who achieved a sustained virological response to directly acting antiviral drugs: is it a concern?

PurposeHepatitis C virus infection is a major health problem in hemodialysis patients. Occult HCV infection is defined as the presence of HCV-RNA in hepatocytes or peripheral blood mononuclear cells without the detection of HCV-RNA in the serum. We aimed to evaluate the prevalence and predictors of occult HCV infection among hemodialysis patients after treatment with direct-acting antiviral agents.MethodsThis research is a cross-sectional study that included 60 HCV patients maintained on regular HD patients who achieved 24 weeks of sustained virological response after treatment with direct-acting antiviral agents. Real-time PCR was performed to detect HCV-RNA in peripheral blood mononuclear cells.ResultsHCV-RNA was detected in peripheral blood mononuclear cells of three patients (5%). Occult HCV infection cases were treated by Interferon/ribavirin before direct-acting antiviral agents and two of them had raised pre-treatment alanine aminotransferase levels. Logistic regression analyses revealed that high pre-treatment viral load and raised pre-treatment alanine aminotransferase were associated with an increased risk of occult HCV infection with p value of 0.041 and 0.029, respectively.ConclusionsOccult HCV infection in hemodialysis patients who achieved sustained virological response after treatment with direct-acting antiviral agents may occur, and this may necessitate dual testing for HCV in both serum and peripheral blood mononuclear cells to ensure viral clearance.Clinical trials registrationClinicalTrials.gov NCT04719338.

Prevalence of hepatitis C virus infection among hemodialysis patients: cohort study

Hepatitis C virus (HCV) is a blood-borne virus that primarily infects the liver and can cause both acute and chronic hepatitis. HCV is one of the leading causes of liver disease worldwide and can lead to cirrhosis, liver failure, and liver cancer if left untreated. Dialysis is the most common reliable and accessible therapeutic approach in end-stage renal disease (ESRD) which increases survival and life expectancy in patients. Despite the screening tests on blood products and devices, nosocomial infections are one of leading causes of morbidity and mortality in ESRD. HCV is more prevalent in ESRD compared to the general population, with an overall prevalence of 9.9% among chronic hemodialysis (CHD) patients in high- and middle-income countries. The objective of this study is to assess the prevalence of occult HCV infection in CHD. All clinical, and demographic data was registered beside blood samples, serological testes and HCV-RNAs from 95 patients; 60.7% were male, with mean age of OCI positive cases was 32.3 ± 14.3 years. Furthermore, three case had detectable viral load which was 54 IU/ml. Inconclusion, there is a risk of OCI among CHD patients that needs follow-up by molecular testing.

Detection of Occult Hepatitis C Virus Infection in Egyptian Patients Who Achieved a Sustained Virologic Response to Direct-Acting Antiviral Agents.

Occult hepatitis C virus (HCV) infection (OCI) is diagnosed based on the detection of HCV-RNA in non-serum reservoirs, such as peripheral blood mononuclear cells (PBMCs) and/or hepatocytes with undetectable HCV-RNA in the serum. The current study was designed to shed more light on the presence of occult HCV in a population of cases who achieved an SVR after receiving treatments for HCV-infection and its significance. This cross-sectional study evaluated 111 chronic HCV patients treated at Theodor Bilharz Research Institute, Egypt and achieved a sustained virological response (SVR) 12 -24 weeks after treatment with Direct acting antiviral drugs (DAAs). The treatment lasted 12 or 24 weeks using generic medications including Sofosbuvir (SOF) 400 mg/day and Daclatasvir (DCV) 60 mg/day ± weight-based Ribavirin (RBV) 600-1000 mg/day. After achieving the SVR 12 -24 weeks, all patients were subjected to clinical examination and full laboratory investigations. All the candidates were assessed for fibrosis pre/post-treatment by transient elastography (Fibroscan©). Eighty-seven patients (78.4%) received dual therapy (SOF/DCV) and 24 patients (21.6%) received triple therapy (SOF/DCV/RBV). One hundred and seven patients received the regimen for 12 weeks (96.4%) and only four patients received the regimen for 24 weeks (3.6%). All patients were examined in terms of HCV RNA in plasma and PBMCs. Nine patients (8.1%) were positive for PBMCs HCV RNA. The presence of Occult HCV infection (OCI) was significantly correlated with age, level of AFP, and the degree of liver stiffness. The OCI was present in 8.1% of the patients who achieved an SVR 12 - 24 weeks. These patients were mostly aged and with elevated AFP and advanced fibrosis. Monitoring and follow-up of those patients may help to assess the outcomes.

Screening of Occult Hepatitis B and C Virus Infection in Working Children, Tehran, Iran

Background: Working children are susceptible to infection with various infectious microorganisms. Unfortunately, the difficulties of working children are growing at a remarkable speed worldwide. Objectives: The aim of this research was to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, as well as to evaluate the level of anemia, calcium, and phosphorus in working children. Methods: This cross-sectional research was performed on 370 Iranian and Afghan working children from February 2018 to May 2019. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb), and anti-HCV Ab were evaluated using an enzyme-linked immunosorbent assay (ELISA). Furthermore, HCV-RNA and genomic HBV-DNA in the plasma and peripheral blood mononuclear cell (PBMC) specimens of the participants were investigated. The restriction fragment length polymorphism (RFLP) method was used to determine the genotype of HCV, and sequencing was performed to confirm. Results: The mean age of the participants was 10.1 ± 2.1 years (range, 6 - 15 years), and 229 (61.9%) were male. None of the studied children had any detectable HBV-DNA in the plasma and PBMC. The HCV genome was not detected in the plasma of the children, but HCV-RNA was assessed in the PBMC sample of 1 child (0.3%). Therefore, one of the children had occult HCV infection (OCI). The genotype of HCV in this child was subtype 1a. Furthermore, HBsAb was detected in Iranian (41.5%) and Afghan children (40.0%), and 2 (0.54%) of the working children were HBsAg positive. In 3 participants (0.8%), a positive HBcAb test result was noted. Conclusions: The prevalence of HCV and HBV infection in working children in Iran is extremely rare. However, there is a possibility of the presence of OCI in these children.

Prevalence of Occult Hepatitis C Virus Infection in Egyptian Patients with Lymphoma: A New Vision.

Occult hepatitis C virus infection (OCI) is the absence of HCV RNA in serum and the presence of actively replicating HCV RNA in hepatocytes and peripheral blood mononuclear cells (PBMCs), as evidenced by the presence of antigenomic negative sense single-stranded RNA. This study aimed to determine the prevalence of OCI in Egyptian lymphoma patients and assess changes in biochemical parameters in patients with confirmed OCI. The current study was conducted on 100 apparently healthy subjects as control group and 100 patients with lymphoma as a case group. HCV RNA was extracted and detected in both plasma and PBMCs using qRT-PCR. Total protein, albumin, ALT, AST, and total and direct bilirubin were measured in serum. OCI was detected in 6% of the patient group. OCI patients had lower levels of total protein and serum albumin and higher ALT and AST compared with lymphoma patients without OCI. Our study revealed that six out of 100 patients with lymphoma disorders had occult HCV infection (6%). Therefore, the possibility of this infection should be considered in patients with lymphoma.

Occurrence and recurrence of hepatitis C-related hepatocellular carcinoma after direct antiviral treatment

Hepatitis C virus (HCV) RNA can be cleared from the blood circulation by direct antiviral treatment to achieve sustained virologic response (SVR). Studies have shown that SVR after direct antiviral therapy can reduce the incidence of hepatocellular carcinoma; however, monitoring for hepatocellular carcinoma is still needed. This review briefly summarizes and discusses the existing studies on the possible causes of hepatitis C secondary to HCC after antiviral therapy, which is mainly divided into epigenetic alterations and abnormal DNA methylation, HCV-related cirrhosis and abnormal DNA amplification, HBV reactivation, several aspects of occult HCV infection, and the effect of direct antiviral treatment on hepatocellular carcinoma recurrence. In few cases, direct antiviral treatment cannot completely prevent the occurrence and recurrence of hepatitis C-related hepatocellular carcinoma. Therefore, its mechanism needs to be studied and explored, and clinicians should also approach it with caution.

Occult Infection with Hepatitis C Virus: Looking for Clear-Cut Boundaries and Methodological Consensus.

The sustained virologic response and elimination of HCV is widely viewed as a true cure of chronic hepatitis C as it associates with amelioration of histological liver damage and improved clinical outcomes. Therefore, the existence and clinical burden of occult HCV infection (OCI) has been a controversial issue for many years. In this review, we summarize recently published data that adds new information on the molecular and clinical background of OCI and its epidemiological significance. We also identify and discuss the most important methodological pitfalls, which can be a source of inconsistency between studies. Data that have accumulated so far, strongly support the existence of extrahepatic HCV replication in individuals negative for serum HCV-RNA by conventional clinical tests. OCI emerges as a condition where the immune system is unable to fully resolve infection but it is continuously stimulated by low levels of HCV antigens, leading to progression of liver pathology and extrahepatic HCV-related complications. Moreover, the development of monitoring strategies or management guidelines for OCI is still hampered by the lack of clear definition and the confusion regarding its clinical significance. Careful study design and the introduction of uniform protocols for the detection of low-level HCV-RNA are crucial for obtaining reliable data on OCI.

Prevalence of Occult Hepatitis C Virus Infection among Egyptian Haemodialysis Patients

Abstract Background Hepatitis C Virus (HCV) infection is a global health problem. OCI is characterized by presence of HCV-RNA in the liver tissue only and/or Peripheral Blood Mononuclear Cells (PBMCs) with undetectable HCV-RNA or antibodies in the serum. Support for presence of this entity comes from the observation that HCV, even though a hepatotropic virus, can replicate as well at extrahepatic sites, including peripheral blood mononuclear cells. Objectives The current study evaluated the hidden infection of hepatitis C virus among patients on maintenance hemodialysis with negative ELISA and PCR by using PCR in mononuclear cells as a marker in these patients. Our study was done in Sharkia Governorate. Patients and Methods In our study, the 60 included subjects had an average age of 48.27 years with range from 19 to 77 years and included 33 males (55%) and 27 females (45%). The subjects had average dialysis duration of 6.51 ± 4.10years with range from 7 months to 19 years. Results Our study showed no statistically significant differences between occult HCV cases and negative cases in frequency of blood transfusion. There were no statistically significant differences between occult HCV cases and negative cases in splenomegaly, hepatomegaly or coarse liver but there was a statistically significant increase in frequency of severe ascites, moderate LL edema and jaundice among occult HCV cases compared to negative cases. There were no statistically significant differences between occult HCV cases and negative cases in urea, creatinine, ALT, AST or albumin. In our study total bilirubin&amp;gt;1.7 and direct bilirubin &amp;gt;0.4 were significant predictors for the presence of occult HCV in hemodialysis patients. Our study showed that there were no statistically significant correlation between viral load in PBMCs and laboratory findings among occult HCV cases. Conclusion Hemodialysis patients are liable for occult HCV infections with a considerable impact on their health. Total and direct bilirubin are predictors of presence of occult hepatitis C infection at cut-off values of 1.7 mg/dl and 0.4 mg/dl respectively.

Prevalence of occult hepatitis C virus infection in beta-thalassemia major patients in Ahvaz, Iran.

Occult hepatitis C virus infection (OCI) is defined by the presence of HCV RNA in peripheral blood mononuclear cells (PBMCs) and liver tissue cells despite the absence of HCV RNA in plasma. Currently, OCI is classified into two types: seropositive OCI (anti-HCV positive and serum HCV RNA negative) and seronegative OCI (anti-HCV and serum HCV RNA negative). Beta-thalassemia is described as a blood disorder that decreases the synthesis of hemoglobin. Repeated blood transfusion is the standard treatment for patients with beta-thalassemia major (BTM), and this increases the risk of exposure to infectious agents. The aim of this study was to investigate the prevalence of OCI among BTM patients. Plasma and PBMCs were collected from 90 BTM patients who were referred to Shafa Hospital in the city of Ahvaz and were screened for HCV antibody using a commercial ELISA kit as the first step. Next, nested RT-PCR was performed on extracts of plasma and PBMCs. HCV RNA from positive PBMCs was sequenced, the sequences were aligned, and a phylogenetic tree was constructed to determine their relationship to reference sequences retrieved from the GenBank database. Seventy-nine out of 90 patients (87.8%) were negative for HCV Ab (seronegative), while 11 patients (12.2%) were seropositive. HCV RNA was found in PBMCs of four patients (66.7%) who were negative for HCV Ab (seronegative) and two patients (33.3%) who were positive for HCV Ab (seropositive). HCV RNA was not detected in plasma samples from these six patients. Six out of 90 BTM patients (6.7%) had OCI. HCV genotyping revealed that all six patients were infected with HCV subtype 3a. We found a high frequency of OCI in BTM patients, which warrants more attention, considering the importance of this infection. Further studies are needed to determine the actual prevalence of OCI in BTM patients in Iran.

Prevalence of Occult HCV Infections in Saudi Patients who Achieved Sustained Virologic Response with Direct Acting Antiviral Treatment

Background: Occult hepatitis C virus (HCV) infection (OCI) is a condition where HCV RNA is present in hepatocytes or peripheral blood mononuclear cells (PBMCs), but not in the serum, in patients treated for hepatitis C infection. Serum HCV antibodies may or may not be present. Aim: We investigated the prevalence of OCI in PBMCs and hepatocytes in patients who had achieved sustained virologic response (SVR) after 24 weeks of direct-acting antiviral treatment.Methods: Chronic HCV patients with Genotype 1a and 4 who achieved SVR 24 weeks after treatment with direct-acting antiviral agents (DAAs) were prospectively selected. RNeasy Blood and Tissue Kit (Qiagen GmbH, Germany) was used for RNA extraction from blood and liver tissue samples. Superscript IV First-Strand Synthesis System (Invitrogen) was used for reverse transcription PCR. Quantitative and qualitative detection of HCV RNA was performed using primers specific to the 5′ untranslated region (5′ UTR).Patients: Of the six chronic HCV patients recruited for this study, five were infected with genotype 4 and one with genotype 1a. Five patients were treated with Sofosbuvir and Daclatasvir, and one patient with Ledipasvir plus Sofosbuvir.Results: None of the patients had detectable HCV RNA in either the PBMCs or hepatocytes, suggesting zero prevalence of OCI in patients who achieved 24 weeks SVR post DAA treatment. Conclusion: We failed to detect HCV RNA in both the hepatocytes and PBMCs of all patients recruited for the study. This finding suggests that OCI is a rare phenomenon and uncommon among immunocompetent patients.

Occurrence and clinical characteristics of occult hepatitis C virus infection in hemodialysis units at Ismailia, Egypt.

Occult hepatitis C infection is defined as the presence of hepatitis C virus RNA in peripheral blood mononuclear cells (PBMC) ± hepatocytes in the absence of HCV-RNA in serum. It has been a lot of debate and controversy in recent years and not discussed well. This issue has not been discussed or investigated in Egypt, especially in patients on hemodialysis in Ismailia. This study is the first one to investigate the prevalence of occult HCV infection in large populations of chronic hemodialysis (CHD) patients in Ismailia, Egypt. Our study is cross-sectional analytic and included 204 CHD patients; who are negative for HCV infection. Sensitive commercial real-time assay was used to detect HCV-RNA in PBMC. In our study, the presence of genomic HCV-RNA in PBMCs of all these patients was detected by real-time PCR. On the other hand, 22 patients on hemodialysis with an established diagnosis of chronic hepatitis C virus infection were included as a control group and examined by real-time PCR was used to evaluate HCV infection. Occult HCV infection is defined as the presence of HCV-RNA in PBMNCs in patients on chronic hemodialysis, and it was found in 14/204 (7%) of the patients. Patients who were on CHD for a longer time are susceptible to occult HCV infection, and their mean alanine aminotransferase levels are significantly higher during the last 3 months before study entry. In comparison, chronic HCV patients have elevated bilirubin, aspartate transferase and alanine transferase than occult HCV infection. The prevalence of occult HCV infection was 7% in our CHD patients. No available data are showing the virulence of this form of virus. However, further studies in other geographic populations with high HCV endemicity are needed to clarify the significance of occult HCV infection in these patient groups, in addition to test for the presence of negative antigenomic strand to confirm or disconfirm the reliability of occult HCV.

Occult hepatitis C virus infection in the Middle East and Eastern Mediterranean countries: A systematic review and meta-analysis.

BACKGROUNDThe presence of hepatitis C virus (HCV) RNA in liver tissue or peripheral blood mononuclear cells with no identified virus genome in the serum has been reported worldwide among patients with either normal or elevated serum liver enzymes. The characterization of occult HCV infection (OCI) epidemiology in the Middle East and Eastern Mediterranean (M and E) countries, a region with the highest incidence and prevalence rates of HCV infection in the world, would be effective for more appropriate control of the infection.AIMTo estimate the pooled prevalence of OCI in M and E countries using a systematic review and meta-analysis.METHODSA systematic literature search was performed using international, regional and local electronic databases. Some conference proceedings and references from bibliographies were also reviewed manually. The search was carried out during May and June 2020. Original observational surveys were considered if they assessed the prevalence of OCI among the population of M and E countries by examination of HCV nucleic acid in peripheral blood mononuclear cells in at least 30 cases selected by random or non-random sampling methods. The meta-analysis was performed using Comprehensive Meta-analysis software based on heterogeneity assessed by Cochran’s Q test and I-square statistics. Data were considered statistically significant at a P value < 0.05.RESULTSA total of 116 non-duplicated citations were found in electronic sources and grey literature. A total of 51 non-overlapping original surveys were appraised, of which 37 met the inclusion criteria and were included in the analysis. Data were available from 5 of 26 countries including Egypt, Iran, Pakistan, Saudi Arabia, and Turkey. The overall prevalence rate of OCI was estimated at 10.04% (95%CI: 7.66%-13.05%). The lowest OCI rate was observed among healthy subjects (4.79%, 95%CI: 2.86%-7.93%). The higher rates were estimated for patients suffering from chronic liver diseases (12.04%, 95%CI: 5.87%-23.10%), and multi-transfused patients (8.71%, 95%CI: 6.05%-12.39%). Subgroup analysis indicated that the OCI rates were probably not associated with the studied subpopulations, country, year of study, the detection method of HCV RNA, sample size, patients’ HCV serostatus, and sex (all P > 0.05). Meta-regression analyses showed no significant time trends in OCI rates among different groups.CONCLUSIONThis review estimated high rates of OCI prevalence in M and E countries, especially among multi-transfused patients as well as patients with chronic liver diseases.

Occult hepatitis C in peripheral blood mononuclear cells in thrombocytopenic patients after achieving sustained virological response with direct-acting antivirals

Background/aim Occult hepatitis C virus infection (OCI) may be present in resolved hepatitis C virus (HCV) after direct-acting antivirals (DAAs). DAAs may improve thrombocytopenia after achieving sustained virological response (SVR), but some patients may be manifested with thrombocytopenia after SVR. The aim of our study was to evaluate the presence of OCI in the peripheral blood mononuclear cells (PBMCs) in thrombocytopenic patients after achieving SVR with DAAs. Patients and methods This cross-sectional study included 32 thrombocytopenic patients who achieved SVR with DAAs and 32 HCV-infected patients who achieved SVR with DAAs without thrombocytopenia as a control group. All patients were investigated for HCV-ribonucleic acid (RNA) in PBMCs, hepatitis C virus core antigen (HCVcAg), platelet autoantibodies, and serum thrombopoietin. Results Among thrombocytopenic, non-thrombocytopenic, and both groups, HCV-RNA in PBMCs were detected in 40.63, 6.25, and 23.44%, respectively, although HCVcAg was detected in 31.25, 3.13, and 17.19%, respectively. The comparisons between thrombocytopenic and non-thrombocytopenic patients regarding HCV-RNA in PBMCs and HCVcAg were statistically significant. Comparisons between thrombocytopenic and non-thrombocytopenic and between positive and negative OCI patients regarding serum thrombopoietin were statistically insignificant. Platelet autoantibodies were detected in 56.25% of thrombocytopenic group. Conclusion Our study is the first to provide insights into the relationship between OCI and thrombocytopenia in patients with chronic HCV after achieving SVR with DAAs. The association between OCI and thrombocytopenia may be explained by autoimmune mechanism.

Prevalence of occult hepatitis C virus infection in hemodialysis patients.

Background:Via hemodialysis, viral infections can be transmitted in patients a new definition of this infection with no increase in liver enzymes, negative HCV-PCR in serum and presence of virus in the liver and peripheral blood mononuclear cell (PBMC) called occult hepatitis C virus (HCV) infection (OCI). We decided to examine the prevalence of occult hepatitis C infection on hemodialysis cases.Methods:The current research is a cross-sectional study on patients with end-stage renal disease (ESRD) who were at three hemodialysis centers in Mazandaran province in Iran during 2012-2014. In this study of 356 patients who were undergoing hemodialysis, 54 patients were excluded due to positive HCV Ab, and the remaining 302 patients were enrolled. The test of all serum samples for HCV-RNA detection of plasma and PBMCs was done by real-time polymerase chain reaction (real-time PCR).Results:There was a significant association between the duration of dialysis with the prevalence of occult HCV infection (P=0.017). Eight (2.65%) patients were positive for HBs Ag and with OCI, but none of them was infected with both hepatitis C and B obviously. Also among the total number of patients, nine patients tested positive for HCV RT-PCR in PBMC in which one of them was positive for serum HCV RNA PCR and was excluded from the study.Conclusion:The results showed that eight patients had an OCI. There was not any association found between age and sex with OCI, but there was a significant relationship between the duration of dialysis with the prevalence of OCI.

Seronegative Occult Hepatitis C Virus Infection (OCI) in a Main Haemodialysis Centre In Pahang, Malaysia

Introduction: Occult HCV infection has a predilection for specific populations such as haemodialysis (HD) patients. The exact natural course, epidemiology, pathogenesis and clinical importance of OCI are unknown. We investigated the existence of OCI among local patients undergoing routine HD at a referral hospital in Pahang, Malaysia. Methods: Serum and peripheral blood mononuclear cells (PMBCs) were collected from peripheral venous blood samples of seropositive (anti-HCV positive) and seronegative (anti-HCV negative) HD patients as well as healthy individuals (negative control group). Inclusion criteria for the seronegative patients included elevated liver enzymes. Both conventional PCR and strand-specific PCR were used to detect the viral RNA and to indicate active viral replication in PBMCs respectively. Direct DNA sequencing was done to confirm the viral HCV RNA and their genotypes. Results: In the majority (90-100%) of seropositive chronic hepatitis C patients, viral RNA was detected in both serum and PMBCs . Meanwhile, out of 22 seronegative patients, 6 (27%) showed active viral replication in PBMCs but no detectable viral RNA presence in the serum. None of the negative control group had detectable viral RNA. All seronegative patients with OCI were infected with HCV genotype 3 and two of them (2/6) had a slight elevation of their liver enzymes. Conclusion: Seronegative OCI does exist among local hemodialysis patients, with normal or persistently abnormal liver enzyme values. Further investigation is needed to study the mode of viral transmission and clinical significance of OCI in HD setting.

Prevalence of occult HCV infections in Saudi patients who achieved sustained virologic response with direct acting antiviral treatment

Prevalence of occult HCV infections in Saudi patients who achieved sustained virologic response with direct acting antiviral treatment

Occult Hepatitis C Virus Infection among Hemodialysis Patients: An Iranian Experience.

Patients with chronic kidney failure and those undergoing chronic hemodialysis (CHD) treatment are at high risk of infection with hepatitis C virus (HCV). The incidence of occult HCV infection (OCI) in CHD remains controversial and the real burden of HCV in this population may be affected by the rate of OCI. This study evaluates the molecular assessment of OCI in CHD in an Iranian population. All subjects on CHD in the South Khorasan province of Iran were invited for participation in the study. Whole blood samples were taken and serological, clinical, and demographic information was recorded. HCV-RNAs were checked in serum and peripheral blood mononuclear cells (PBMCs) using an in-house semi-nested PCR assay. Viral load was determined using a real-time PCR-based quantification kit. Sequencing was performed to determine genotypes. Overall, 120 cases participated in the study; 57.5% were male and the rest were female. In serum samples, no positive case was found for HCV-RNA. In PBMC samples, 2/120 (1.6%) were positive for HCV-RNA (95% CI, 0.002 to 0.059); the mean age of OCI positive cases was 37.5 ± 19.2 years which was significantly lower than OCI negative cases (P = 0.026). Only one case had detectable viral load which was 49 IU/mL. The only HCV genotype identified was 1a. This study showed that there is a risk of OCI among CHD patients; the very low and undetectable viral loads of OCI warrant further follow-up molecular testing for earlier diagnosis and treatment in the era of DAA.