Prevalence and Risk factors of overt- and occult Hepatitis C virus infection among Chronic Kidney Disease patients under regular Hemodialysis in Egypt

Background: hepatitis C virus [HCV] infection is a major health problem. It is more prevalent among chronic kidney disease [CKD] patients. Occult HCV infection, a new, entity has been described

Aims: to find out prevalence of occult HCV infection among CKD patients under regular hemodialysis [RHD] and to define epidemiology of HCV infection among them

Patients and Methods: a sample of 100 CKD patients under RHD was recruited. A questionnaire form was used to collect data. HCV-RNA was tested in serum to detect overt HCV infection patients. HCV-RNA was tested in peripheral blood mononuclear cells of undetected HCV-RNA patients' serum to determine those with occult HCV infection. Rest of the patients was considered HCV free. Biochemical tests were done to all patients

Results: prevalence of overt and occult HCV infection among CKD patients under RHD was 34.0% and 27.3%, respectively. Liver and renal function tests were significantly higher among the overt and occult HCV patients compared to negative HCV patients. Liver function tests were significantly lower among the occult compared to overt HCV patients. Overt HCV patients had significant risk factors compared to negative HCV patients; age group 40-59 years [OR=9.34] and rural residence [OR=3.14]. Also, significant clinical risk factors were the overweight, history of blood transfusion 5>/= times/year, history of nonmedical bloody manipulations, and history of IV drug abuse [OR=3.23, 5.96, 8.28, 7.08, respectively]. Occult HCV patients had significant risk factors compared to negative HCV patients; age group 60 >/= years and rural residence [OR=6.25 and 6.73, respectively]. Significant clinical risk factor was the history of nonmedical bloody manipulations [OR=11.5]

Conclusions and Recommendations: prevalence of overt- and occult HCV infection is high in CKD patients under RHD; this has important clinical and public health implications. There are many significant socio-demographic and clinical risk factors for these infections. A close monitoring of the HD patients and testing them for HCV-RNA in PBMCs yearly to adopted a proper management. Also, more studies on bigger number of patients are required to understand real epidemiology of this health problem

Study of lymphocyte phenotyping of peripheral blood in HCV-infected patients and its relation to autoimmunity

Hepatitis C virus [HCV] infection is associated with immune mediated abnormalities and B- cell lymphoproliferation. CD81 was identified as an HCV receptor on B-lymphocytes. The antigen CD19 is associated with CD81 B-cells at different stages of maturation. Expression of CD5 lymphocytes was associated with non- HCV related autoimmune disorders. Therefore we try to evaluate the clinical significance of B-lymphocyte phenotyping of peripheral blood [PB] in HCV- infected patients [age range 10-16 Years] with and without the autoimmune markers rheumatoid factor [RF], antinuclear antibody [ANA], and anti-double stranded DNA [Anti ds DNA], where PBCD5, CD19 and CD81 expression were determined in 20 EDTA blood samples of healthy persons [group I] and 40 blood samples of HCV- infected persons [25 with negative autoimmune markers [group IIa] and 15 with positive autoimmune markers [group IIb]]. Age [10-16 years]. Flow cytometry was used to estimate percentage of antigen expression of CD5, CD19 and CD81 over B-lymphocytes. Indicated that CD5 expression was significantly increased in group IIb than group IIa and group I [28 +/- 3.2%, 25 +/- 4.2% and 13.3 +/- 5.8% respectively p < 0.0001]. The same increase occurs in the mean values for CD19 [group I 3.5 +/- 1.6%, group IIa 14 +/- 2.5% and group IIb 23 +/- 3.1% p< 0.0001], while CD81 mean values were group I 50 +/- 28%, group IIa 78 +/- 16% and group IIb 92 +/- 12%. Increased expression of CD5, CD19 and CD81 on B-lymphocytes in HCV- infected patients with higher values with positive autoimmune markers, suggests the high clinical significance of peripheral blood B-lymphocyte phenotyping as a predictive and diagnostic tool for autoimmune serconversion in HCV-infected patients. Also it can be a prognostic guide for successful treatment or highlight for new antiviral and autoimmune treatment