Serum level of interleukin-8 and interleukin-10 as predictors for response to interferonribavirin combined therapy

Background: In Egypt, the prevalence of hepatitis C virus infection is high [about 20%]. Chronic hepatitis C [CHC] is a slowly progressive disease complicated by liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Treatment of CHC with pegylated interferon-alpha [peg-IFN-alpha]/ribavirin [RBV] combination therapy was the standard of care therapy until 2014 and is used until now in some regimens with new direct acting antiviral drugs. Some hepatitis C virus proteins [core, E2, NS4A, NS5A, and NS2] induce interleukin-8 [IL-8], which inhibits the antiviral activity of IFN-alpha. It was found to be significantly higher in patients with nonsustained virological response [non-SVR] than in patients with SVR to IFN/RBV therapy. IL-10 is a Th2 cytokine, and an imbalance between Th1/Th2 immune response could influence the clinical course of CHC and response to treatment. Some studies showed that pretreatment IL-10 serum level is much higher in patients with non-SVR than in those with SVR to therapy and could be considered as a good predictor for response to IFN/RBV therapy

Aim of the work: The aim of the study was to determine pretreatment serum levels of IL-8 and IL-10 in Egyptian CHC patients and their value in the prediction of response to peg-IFN/RBV therapy

Patients and methods: This study included 75 CHC Egyptian patients and 14 healthy individuals [control group]. Pretreatment serum levels of IL-8 and IL-10 were measured and then CHC patients were subjected to peg-IFN/RBV therapy

Results: SVR was achieved in 64% of treated CHC patients, whereas 36% were non-SVR. Serum levels of IL-8 and IL-10 were significantly lower in controls than in CHC patients and in the SVR than in the non-SVR group

Conclusion: We can consider serum IL-8 and IL-10 pretreatment levels as good predictive noninvasive markers to predict SVR to peg-IFN and RBV therapy in CHC patients

Occult hepatitis B virus infection among chronic hemodialysis patients in Alexandria, Egypt

The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus [HBV] infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus [HCV] and hepatitis B core [HBc] antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase [ALT and AST] were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant [p = 0.001]. HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity [p = 0.021]. Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV [p < 0.05]. In conclusion, the serological markers of HBV infection should be verified with molecular tests to investigate possible occult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics

Hepatitis C virus infection in patients with systemic lupus erythematosus: clinical and immunological study

This study aimed at detecting the prevalence of HCV infection in systemic lupus erythematosus patients [SLE] and its clinical and immunological impact on these patients. 75 patients with SLE were randomly selected and 100 volunteers of blood donors were enrolled as a control group. After full careful clinical assessment, disease activity index [SLEDAI] was determined to all patients and all subjects were investigated by complete blood picture, liver enzymes and HCV antibodies by third generation ELISA. Subjects with positive antibodies were further investigated for viremia by HCV PCR. Immunological tests included C3, C4, ANA, Anti ds-DNA and cryoglobulin. Patients were divided into 2 groups according to presence or absence of HCV antibodies. Thirty two of SLE patients [43%] had positive HCV antibodies compared to 1 2[12%] of the control group while only 8 [11%] patients with SLE had detected viremia by PCR. Eighty eight percent of SLE patients with positive HCV antibodies had higher frequency of high disease activity index, 75% had elevated liver enzymes, 59% showed hypocomplementenemia and 63% had cryoglobulinemia. Cutaneous manifestations of SLE were found in 74% of SLE patients without HCV compared to 38% of those with HCV infection. SLE patients had higher prevalence of HCV infection than the general population. SLE HCV patients have less cutaneous manifestation, more frequent high disease activity index, hypocomlementenemia and cryoglobulinemia. Differentiating patients with HCV infection with clinical finding mimicking that of SLE [lupus like syndrome] from those with SLE associated with HCV infection is difficult. In this regard cutaneous manifestation could be a helpful sign. However, more specific serum markers for SLE are needed especially in our locality

Is oesophageal band ligation superior to injection sclerotherapy of varices?

Patients who have bleeding from oesophageal varices are at high risk for rebleeding and death Although endoscopic injection sclerotherapy is widely used to treat bleeding oesophageal varices effectively, it has several complications. Endoscopic band ligation of the varices claimed to be more safe and effective. In this study, we assessed the efficacy and safety of endoscopic variceal ligation [EVL] and compared the results with those of endoscopic injection sclerotherapy [ES] 183 hospitalized patients with first episode of endoscopically proved bleeding oesophageal varices were included in the study. They were randomized Into 2 groups group [1] treated with EVL [n=91] and group [II] treated with ES [n=92]. The 2 groups were followed up and compared for control of acute variceal bleeding, variceal obliteration, rebleeding, complications of the treatment and survival rate Base - line data showed no statistically significant differences in both groups. In group I, the bleeding was successfully controlled in 97.8% compared to 94.6% in group II [NS]. Also the rebleeding rate showed no statistically significant difference in both groups [28.6% and 32.6% in group I and group II respectively]. Variceal obliteration rate showed no statistically significant difference between both groups [64.8% and 68.5% in group I and group II. respectively]. As regard the complication after treatment, there was a statistically significant difference in the incidence of chest pain [15.4% and 100% in group I and II respectively], fever [46.2% and 25% in group I and II respectively] and the incidence of pleural effusion [0% and 12% in group I and II respectively]. But no changes in mortality [4.4% and 3.3% In group I and II respectively, NS]. Both techniques [EVL and ES] were effective without big advantage of one over the other, but every one has preferable situations. Combination of both techniques may be better than either one alone