Evaluation of the HCV core antigen assay as a second-line supplemental test for diagnosis of active hepatitis c infection

Hepatitis C virus core [HCV] antigen assays have been produced to exclude infectious donations collected the preseroconversion window phase. For the same purpose, we evaluated the specificity and sensitivity of a novel hepatitis C virus core antigen detection immunoassay and the applications of this assay in clinical diagnosis. Samples were collected from 30 anti-HCV antibody negative healthy subjects [Gi], and 46 anti-HCV antibody positive patients [G2]. All included samples were subjected to HCV core antigen and HCV-RNA PCR. Among the 46 anti-HCV Ab positive samples, HCV core antigen was positive in 38 samples from 40 samples positive for HCV-RNA with sensitivity of 95% [38/40]. All the 30 anti-HCV Ab negative samples [n=30] were negative for both HCV core antigen and HCV-RNA with specificity of 100% .There was no significant variation in the sensitivity of HCV core antigen between genotype 1 [100%] and genotype 4 [94.5%]. Viral load in HCV core antigen positive samples [906653 +/- 133803] was significantly increased than that of HCV core antigen negative samples [16342 +/- 5245] with P value<0.05. HCV core antigen assay is a useful method in screening strategy of HCV infection and provides a reliable means of distinguishing between current and cleared HCV infections that is well correlated with HCV-RNA testing

HCV genotype and "Silent" HBV coinfection: two main risk factors for a more severe liver disease

To evaluate whether HCV genotype and "silent" HBV infection may be related to a more severe clinical presentation of liver disease. 40 anti-HCV/HCV-RNA positive, HB5Ag/anti-HB5 negative patients with chronic hepatitis [27 males and 13 females, median age 43 +/- 6.98] years, were studied on presentation at National Liver Institute, Menofia University. Presence of serum anti-HBc, in absence of HBsAg and anti-HBs, was considered a marker of "silent" HBV infection. Two main diagnosis groups were established: the mild liver disease group [G1 n20], and the severe liver disease group [G2 n20]. The prevalence of silent HBV infection in HCV patients was 50% where out of the 40 anti-HCV/HCV-RNA positive, HBsAg and anti-HBs negative patients with a definite diagnosis, 20 patients [50%] were anti-HBc positive. Of the 20 anti-HBc positive patients, HBeAg/anti-HBc system was investigated, where 14 patients [70%] were anti-HBe positive and 6 patients [30%] were anti-HBe negative. None of these 20 patients was HBeAg positive. Twelve [60%] out of the 20 HBcAb ve cases were found to be positive for serum HBV-DNA by PCR. In the present study, it was found that the prevalence of a severe liver disease was higher in anti-HBc positive cirrhotic HCV patients lacking both HBsAg and anti-HBs [silent HBV infection] than in cirrhotic HCV patients with no markers of HBV infection [80% vs. 20%, P<0.001], indicating that a "silent HBV infection" may unfavorably influence the course of the disease. This was observed both in HBV-DNA positive and in HBV-DNA negative patients and regardless HCV genotype. Silent HBV infection seems to be a major risk factor for an unfavorable course of the disease. The observation that anti-HBc positive/HBV-DNA negative patients show a similar prevalence of severe liver disease to anti-HBc/HB V-DNA positive patients and a significantly higher prevalence than anti-HBc negative cases supports further the view that isolated serum anti-HBc is a marker of clinical significance

Randomized, comparative study of clinical and metabolic parameters among continuous, extended, and cyclic combined oral contraceptive pill users

This open, prospective, randomized, comparative study evaluated clinical, metabolic, and histopathological aspects of cyclic, extended, and continuous use of a COC containing 30 micro g EE and 75 micro g gestodene [Gynera] in 245 women for 18 cycles. Continuous [82 women] and extended [80 women] pill users had significantly fewer bleeding days requiring sanitary protection than cyclic users [83 women]. Spotting increased initially in continuous and extended pill users but declined after the 4[th] cycle. Amenorrhea rates increased significantly after the 4[th] cycle reaching 85% and 71.4% in the last cycle in continuous and extended pill users, respectively. No significant changes in BP or weight as well as a significant increase in hemoglobin concentration were observed in all study groups. No significant changes in lipid profile were observed except a significant increase in HDL-cholesterol in the continuous group. Insulin levels increased significantly with no associated change in glucose levels in all study arms. A significant increase in both fibrinogen and PAI-1 and a significant reduction in PT without changes in other coagulation parameters were observed in all study arms. Continuous and extended COC pill use for 18 cycles was well tolerated with satisfactory clinical effects and good compliance without changes in BP or weight. The treatment was associated with high rates of amenorrhea after the 4[th] cycle, less severe adverse effects, and metabolic changes similar to those in cyclic users

Fas antigen in serum and liver tissue of patients with chronic hepatitis C

Fas [APO-1/CD95], a member of the tumor necrosis factor receptor Family, can mediate apoptosis when engaged by its ligand or by anti-Fas antibody. Fas is upregulated on the surface of hepatocytes in patients with a variety of liver pathologies, including hepatitis, alcoholic cirrhosis, and acute liver failure. Moreover, expression of Fas ligand is substantially upregulated, in areas of lymphocytic infiltration, in liver diseases, suggesting Fas/FasL interactions may mediate liver damage in humans. The purpose of this study was to evaluate the relationship of serum soluble Fas [sFas] levels and hepatic Fas antigen expression with the degree of hepatic inflammatory activity in patients with chronic hepatitis C infection. The effect of concomitant schistosomiasis, as an endemic liver disease in Egypt, on serum and liver Fas expression was also studied. Serum sFas levels were measured by enzyme-linked immunosorbant assay in 69 chronic hepatitis C patients; 16 of them were under 18 years and compared with those in normal volunteers, and patients with chronic HBV infection. The results of serum tests were compared with ALT levels. HCV-RNA titer, histological inflammatory activity, and Fas expression in liver biopsies. The effect of combined HCV infection and schistosomal infestation on serum sFas and tissue Fas expression was also studied. Serum sFas and tissue Fas expression were then evaluated with each components of histological inflammatory activity scoring system [modified Knodell's HAI]. Serum sFas levels in chronic hepatitis C patients were significantly higher than those in normal volunteers [p<0.001]. They showed no difference from those in patients with chronic HBV infection [p>0.05]. Hepatic schistosomiasis didn't affect serum sFas levels or tissue expression of Fas antigen in chronic hepatitis C patients. Histologically, serum sFas levels showed strong correlation with tissue Fas expression [p<0.001] and with the degree of hepatic inflammatory activity [p<0.01]. Likewise, tissue Fas expression correlated with the degree of histological inflammatory activity [p<0.05]. Moreover, positive correlation was found between serum sFas and tissue Fas expression and the degree of interface hepatitis [piecemeal necrosis] in chronic hepatitis C patients with mild [p<0.01] and moderate and severe activity [p<0.05]. However, no correlation was observed between serum sFas and serum ALT levels. Also, no correlation was observed between HCV-RNA titer and sFas levels or tissue Fas expression. Our findings suggest that serum sFas levels may reflect the expression of Fas antigen on hepatocytes and the severity of liver inflammation in chronic hepatitis C and may be used as a serological indicator of histological inflammatory activity. They also support the concept that immune-mediated apoptosis may play a crucial role in the pathogenesis of chronic hepatitis C. Hepatic schistosomiasis seems to have no impact on serum sFas levels or hepatic tissue Fas expression

Oxidant sress and chronic liver diseases in children

Oxidative stress, which can be identified as increased exposure to oxidant and/or decreased antioxidant capacities, is widely recognized as a central feature of many diseases. To Identify the importance of oxidant stress in the pathogenesis of chronic liver disease, this study was carried out on 51 children with chronic liver diseases [18 viral hepatitis, 12 bilharzial hepatosplenomegally, 11 glycogen storage disease and 10 Wilson cases] and 15 apparently healthy children as controls. The results showed that, the serum lipid peroxide level in the cases was [5.33 +/- 0.22 nmol / ml which was significantly higher than controls [4, 27 +/- 0.31 nmol/ ml]. While the serum level of vitamin A in patient groups [18.39 +/- 4.98 micro g/ dl] was significantly lower than controls [42.96 +/- 10 ug / dl] At the same time the plasma level of vitamin E in patient groups [253.25 +/- 84.32 ug/dl] was significantly lower than controls [736.86 +/- 74, 4 ug/dl. A significant negative correlation was found between serum lipid peroxide and both of serum vitamin A and plasma vitamin E in all studied patient groups. The significant increase of lipid peroxide and decrease of serum vitamin A and plasma vitamin E as antioxidants, give a good evidence for oxidant stress in children with chronic liver diseases