[Incidence of Thyroid Dysfunction among chronic hepatitis C Egyptian patients treated with Interferon/Ribavirin therapy]

Background/Aim: The use of pegylated interferon-alpha [IFN-alpha] and ribavirin is still an integral part of the standard of care treatment of chronic hepatitis C [CHC] in Egypt until the present time, even after introducing the new era of direct acting antiviral drugs. Such regimens are accompanied by the production of autoantibodies that carries the risk of development of thyroid dysfunction [TD]. The study tries to describe the incidence, long-term outcome, and predictors of TD among Egyptian patients with CHC receiving IFN-based treatment

Patients and Methods: Between January 2013 and August 2014, a prospective study design was conducted to include naive CHC patients [virologically and histopathologically proved] enrolled for INFbased therapy with normal thyroid function profile

Results: A total of 400 patients [mean age was 37.4+9.6 years, 18% were females] were included. At the end of the study period, 12.3% of patients [n=49] developed biochemical TD [TSH<0.3 or >5.0 mIU/L]. At the 12th week after the end of antiviral therapy, 67.3% of them [n=33] were spontaneously normalized. At the 24[th] week, 14.3% of the remaining [n=7] had spontaneously normalized. Female gender was significantly associated with the development of TD

Conclusions: The incidence of TD among the Egyptian patients treated by INF-based antiviral therapy for CHC is not low and more predominant in females. Spontaneous recovery after the end of treatment was common however, it entails a strict follow up

Insulin resistance, steatosis, and fibrosis in Egyptian patients with chronic hepatitis C virus infection

Both nonalcoholic fatty liver disease [NAFLD] and chronic hepatitis C virus [HCV] infection are common in Egypt, and their coexistence is expected. There is controversy regarding the influence of NAFLD on chronic HCV disease progression. This study evaluates the effect of NAFLD on the severity of chronic hepatitis C [CHC] [necroinflammation and fibrosis] and assesses the relative contribution of insulin resistance syndrome to the occurrence of NAFLD in patients with chronic HCV infection. Untreated consecutive adults with chronic HCV infection admitted for liver biopsy were included in this study. Before liver biopsy, a questionnaire for risk factors was completed prospectively, and a blood sample was obtained for laboratory analysis. Our study included 92 male patients. Their mean +/- SD age and aspartate aminotransferase [AST] level were 42 +/- 7.7 years [range 20-56] and 68 +/- 41.7 U/L [range 16-214], respectively. The mean insulin level and insulin resistance index were 15.6 +/- 18.3 mlU/mL [range 5.1-137.4] and 5.9 +/- 15.2 [range 0.9-136.2], respectively. Fifty four percent of patients had steatosis and 65% had fibrosis. In multivariate analyses, steatosis was associated with insulin resistance and fibrosis was associated with high AST level, age >40 years, and steatosis. Steatosis is a histopathologic feature in >50% of patients with chronic HCV infection. Insulin resistance has an important role in the pathogenesis of steatosis, which represents a significant determinant of fibrosis together with high serum AST level and older age