Protocolo clínico e diretrizes terapêuticas para hepatite C e coinfecções / Clinical protocol and therapeutic guidelines for hepatitis C and coinfections

INTRODUÇÃO: As hepatites virais são uma das maiores causas de transplantes hepáticos no mundo - com destaque para a hepatite C (HCV), um agravo que hoje afeta mais de 185 milhões de pessoas em todos os continentes. Inicialmente denominada hepatite não-A não-B, a hepatite C foi elucidada apenas em 1989, com a identificação de seu agente etiológico. Desde então, a infecção pelo HCV adquiriu especial relevância entre as causas de doença hepática particularmente entre pacientes portadores do HIV em terapia antirretroviral, grupo que apresenta importante morbimortalidade para o agravo. A história natural do HCV é marcada pela evolução silenciosa: muitas vezes, a doença é diagnosticada décadas depois da infecção. Os sinais e sintomas são comuns às demais doenças parenquimatosas crônicas do fígado e costumam manifestar-se apenas em fases mais avançadas da doença. Estas características também afetam negativamente o diagnóstico da infecção, contribuindo para os números de portadores assintomáticos em todo o mundo. OBJETIVOS: O novo Protocolo Clínico e Diretrizes Terapêuticas para Hepatite C e Coinfecções tem como objetivo oferecer, no âmbito do SUS, uma estratégia custo-efetiva para o tratamento da hepatite C - com novas terapêuticas, acesso flexibilizado, menores índices de efeitos adversos e maior expectativa de cura. Esta proposta inovadora foi pautada também em uma ampla negociação de preços para alcançar a sustentabilidade e o acesso universal à assistência no SUS. O novo PCDT também apresenta uma proposta de cuidado integral ao paciente portador de hepatite viral, além de tratamentos que permitem melhor assistência e ampliação da capacidade do SUS. Assim, são objetivos desta publicação: -Estabelecer novas diretrizes terapêuticas nacionais e orientar os profissionais de saúde no manejo da hepatite C e coinfecções, visando estabelecer uma política baseada nas melhores evidências da literatura científica; -Promover assistência humanizada e especializada; -Buscar melhor qualidade na assistência e uso racional do arsenal terapêutico e demais insumos estratégicos; -Garantir melhores resultados em saúde pública e a sustentabilidade do acesso universal ao tratamento; -Reduzir a probabilidade de evolução para insuficiência hepática e câncer hepático. METODOLOGIA: Com o intuito de apresentar as melhores evidências científicas publicadas e as estratégias estabelecidas, realizou-se a revisão de protocolos internacionais (American Association for the Study of Liver Diseases, 2014; National Institute for Health and Care Excellence; The European Association for the Study of the Liver, 2015; Asian Pacific Association for the Study of the Liver, 2012; World Health Organization, 2014) e de literatura científica. As recomendações deste Protocolo Clínico e Diretrizes Terapêuticas para a Hepatite C e Coinfecções foram pesquisadas nas bases de dados MEDLINE, com o termo de busca "("Hepatitis C/drug therapy"[Mesh] OR "Hepatitis C/therapy"[Mesh])" e com os filtros "Clinical Conference, Clinical Trial (I, II, III, IV), Consensus Development Conference, Evaluation Studies, Guideline, Meta-Analysis, Multicenter Study, Practice Guideline, Randomized Controlled Trial, Review, Systematic Reviews" e "Humans" e data de publicação nos últimos cinco anos; e a base de dados LILACS, com o descritor "hepatite C". Esta busca resultou em 5.336 e 122 publicações, respectivamente. Complementou-se esta pesquisa com uma revisão sistemática realizada pelo Departamento de Gestão e Incorporação de Tecnologias em Saúde (DGITS/SCTIE/MS), que identificou as últimas evidências de estudos clínicos realizados com os medicamentos propostos neste documento. (Departamento de Gestão e Incorporação de Tecnologias no SUS, 2015) Bases de dados consultadas pelo DGITS/SCTIE/MS: MEDLINE, Cochrane Collaboration, DARE, Central, Clinicaltrials.gov e anais dos últimos eventos científicos internacionais em hepatites virais. CONSULTA PÚBLICA: A consulta pública para a aprovação do Protocolo Clínico e Diretrizes Terapêuticas para Hepatite C e Coinfecções foi realizada entre os dias 22 de junho e 01 de julho de 2015. Foram recebidas 53 contribuições durante a consulta pública. Somente são consideradas contribuições de consulta pública aquelas que foram encaminhadas no período estipulado em formulário próprio. As 53 contribuições foram analisadas pelo Departamento de DST, Aids e Hepatites Virais, responsável pelo programa/ação de que trata o protocolo e pelo Plenário da CONITEC, tendo sido agrupadas por tema. DELIBERAÇÃO FINAL: Os membros da CONITEC presentes na reunião do plenário do dia 02/07/2015 deliberaram, por unanimidade, recomendar a aprovação do Protocolo Clínico e Diretrizes Terapêuticas para Hepatite viral C crônica. DECISÃO: Portaria nº 37, de 24 de julho de 2015 - Torna pública a decisão de aprovar o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) para Hepatite viral C crônica no âmbito do Sistema Único de Saúde - SUS.

Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus

BACKGROUND: Previous studies have shown that some viral infections may be triggers for autoimmune diseases. The role of viral infections in the etiopathogenesis of pemphigus has also been investigated. OBJECTIVES: To investigate the relationship between pemphigus and the hepatitis B and C virus infections. METHODS: This retrospective study included 62 patients with pemphigus and 50 healthy controls of matching ages and genders. The control group included relatives who accompanied the orthopedic patients to the hospital but had no history of systemic and/or autoimmune diseases. RESULTS: The group of patients with pemphigus was composed of 43 (69.3%) females and 19 (29.7%) males, and the mean age was 48.08 ± 15.38. The hepatitis C virus antibody was negative in all of the patients. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), or both, were studied in 44 of the 62 patients. Two (4.3%) of these patients were positive for HBsAg and found to have HBV infection. Fourteen of them were HBsAb positive. Two (4%) of the 50 control subjects showed hepatitis C virus antibody positivity, while only 1 (2%) patient with pemphigus displayed HBsAg positivity. There was no statistically significant difference between the two groups for hepatitis B and C virus infections. CONCLUSIONS: This study does not support an association between pemphigus and hepatitis B and/or C virus infections. .

Oral lichen planus and Hepatitis C virus infection: an epidemiological study of 149 cases / Liquen plano oral e infección del virus de la Hepatitis C: un estudio epidemiológico de 149 casos

The objective of this investigation was to assess the prevalence of oral lichen planus (OLP) in Moroccan patients infected with hepatitis C virus (HCV) from the Hepatology service of Ibn Sina University hospital of Rabat. The study group consisted of 149 patients with HCV infection. All patients with clinical features of OLP were submitted to the service of oral surgery for confirmation. Among the 149 HCV-infected patients of the study group, 35 patients had OLP which represents a prevalence of 23.5 percent. Two out of these 35 patients with OLP-HCV association had cutaneous lichen planus (CLP) as well. Our findings indicate that there is a significant association between OLP and HCV infection especially for reticular and erosive types of OLP.

El objetivo de esta investigación fue evaluar la prevalencia de liquen plano oral (LPO) en los pacientes marroquíes infectados con hepatitis C (VHC) del Servicio de Hepatología del Hospital Universitario Ibn Sina de Rabat. El grupo de estudio consistió de 149 pacientes con infección por el VHC. Todos los pacientes con características clínicas de LPO se presentaron al servicio de cirugía oral para su confirmación. Entre los 149 pacientes infectados por VHC del grupo de estudio, 35 pacientes presentaban LPO, una prevalencia de 23,5 por ciento. Dos de estos 35 pacientes con LPO asociado al VHC tenían también liquen plano cutáneo (LPC). Nuestros hallazgos indican que existe una asociación significativa entre la LPO y la infección por el VHC, especialmente para los tipos de LPO reticular y erosivo.

Comparison of different ICT kits for HBsAg and anti HCV using gold standard ELISA

To compare rapid tests [ICT] with 4[th] generation ELISA [gold standard] for hepatitis B and C infection. Biochemistry and Serology Laboratory of the Pakistan Medical Research Council, Research Centre, Jinnah Post Graduate Medical Centre, Karachi. Study was done over six months. ELISA confirmed 200 samples for HBsAg and 200 for Anti-HCV were selected, making a total of 400 samples. Out of 400 samples, 200 were positive and 200 negative on ELISA. These samples were further tested on three different brands of most frequently used rapid ICT Kits for HBsAg and Anti HCV. The sensitivity, specificity, negative predictive value, positive predictive value and cost effectiveness were compared using 4[th] generation ELISA as gold standard. The Rapid kits for HBsAg that were analysed included Acon [USA], Determine [Abbott] and Intec [China] and for Anti HCV they were Acon [USA], Membrane [Canada] and Nobis [Germany]. Out of 100 positive and 100 negative tests for HBsAg confirmed on ELISA, all rapid kits showed comparable results with ELISA. The sensitivity and negative predictive value of Intec China [98%] and Determine Abbot [98%] were similar to each other however, these were higher when compared to Acon USA [95%]. The rapid kit by Intec China was cheaper to the other two rapid kits and was therefore, the most cost effective rapid kit. The specificity and positive predictive value of all three HBsAg ICT kits was 100% and in agreement with ELISA. Out of 100 HCV positive and 100 HCV negative cases confirmed on ELISA, the rapid test by Acon USA showed maximum sensitivity. The sensitivity and negative predictive values of Acon USA were higher [93%] as compared to Membrane - Canada [89%] and Nobis- Germany [86%]. The specificity and positive predictive values of Acon were comparatively lower [93%] but did not significantly vary when compared with Membrane Canada [97%] and Nobis German [96%]. The rapid ICT Kits for HbsAg and anti HCV were equally sensitive and specific when compared with ELISA. These rapid kits are cheaper and easy to perform and their use should be encouraged especially in rural setting. ELISA confirmed rapid HBV, HCV kits being cheaper but sensitive and specific should be used for screening cases especially in rural setting

An evaluation of saliva as an alternative to plasma for the detection of hepatitis C virus antibodies.

PURPOSE: Seroepidemiological studies on the prevalence of Hepatitis C virus (HCV) in India have been hampered by reluctance of subjects to provide blood samples for testing. We evaluated the use of saliva as an alternate specimen to blood for the detection of antibodies to HCV. METHODS: Chronic liver disease (CLD) patients attending the liver clinic were recruited for this study. A saliva and plasma sample (sample pair) was collected from each patient included in the study. Saliva samples were collected using a commercially available collection device--OmniSal. Sample pairs were tested with an in-use ELISA for the detection of antibodies to HCV (HCV-Ab), with a minor modification in the manufacturer's protocol while testing saliva. The cut-off absorbance value for declaring a sample as positive was determined by receiver operating curve (ROC) analysis. HCV-Ab positivity in saliva was compared with that in plasma as well as with viral load in plasma and infecting genotype of the virus. Sensitivity, specificity, positive and negative predictive values, and correlation coefficients were calculated using Medcalc statistical software. RESULTS: The optimal accuracy indices were: sensitivity-81.6%; specificity-92.5%; PPV-85.1% and NPV-90.5%. No correlation was found between salivary positivity and HCV viral load in plasma or infecting genotype. CONCLUSIONS: The accuracy indices indicate that the assay must be optimized further before it can be recommended for routine use in epidemiological surveys for HCV-Ab.

Seroprevalencia del Virus de la Hepatitis B y C mediante la reactividad a los marcadores serológicos / Seroprevalence of the Virus of hepatitis B and C through the reactivity to the sexological markers

En Bolivia estudios epidemiológicos sobre patologías producidas por virus hepatotróficos son escasos, debido a ello sus patrones de circulación son practicamente desconocidos. En el presente trabajo se reporta la seroprevalencia de infecciones por virus por virus de la hepatitis B y C.

Nitric oxide levels are not changed in saliva of patients infected with hepatitis C virus

O objetivo desta investigacão foi avaliar os níveis de metabólitos do óxido nítrico na saliva de pacientes anti-vírus da hepatite C positivos na tentativa de correlacionar os níveis desses metabólitos com a presenca do VHC na saliva. Foram estudados 39 pacientes anti-VHC positivos (9 com enzimas hepáticas normais, 16 com hepatite crônica e 14 com cirrose hepática) e em 13 controles saudáveis, sem sinais ou sintomas de doenca hepática.O RNA do VHC foi identificado no soro e na saliva através de técnica de RT-PCR e os níveis de óxido nítrico foram avaliados pela quantificacão dos seus metabólitos estáveis, nitratos e nitritos. Os resultados demonstraram que os níveis de nitrito na saliva não diferiram significativamente no grupo anti-VHC positivo em relacão ao grupo controle, nem entre os grupo com presenca ou ausência do RNA do VHC na saliva. Os níveis de nitrito foram mais elevados no grupo com cirrose hepática do que nos grupos controle e anti-VHC positivos, sem cirrose hepática, mas as diferencas não foram estatisticamente significativas. A não observacão de níveis elevados de nitrito na saliva dos pacientes anti-VHC positivos é uma indicacão indireta de que a sialoadenite não deve ser freqüente nesses pacientes ou, se existe, é de intensidade não suficiente para modificar os níves de óxido nítrico na secrecão salivar.

Hepatitis C in Jordan blood donors

To study the sero prevalence rate of hepatitis C antibodies among blood donors in the North of Jordan. A retrospective study carried out at Prince Rashid Ben Al Hassan Hospital over one year period [1999]. 21000 eligible blood donors in the North of Jordan were screened for Hepatitis C antibodies. Their data were collected from Prince Rashed Military hospital and National Blood Bank in the Northern part of Jordan. Fresh blood samples were drawn from all donors. Serum was separated and stored at - 20°C until it was tested. All blood samples were tested in laboratories using the same standardized methods and equipment. HCA was detected using the ELIZA test [Organon Tekaika]. A total of 21000 [19550 males, 1450 females] blood donors were screened for HCV Antibodies. The prevalence of HCY Antibodies seropositives among the study populations was 1.1% and the prevalence in males and females were 1.8% and 0.6% respectively. The peak age range of positive HCV Antibodies donors was from 35-39 yeas. We concluded that seropositivity in our donors is still significant. Therefore, expanded immunization programme must be introduced taking into account all age groups. Future studies are needed to determine the prevalence of HCV Antibodies

Clinico-cytopathological spectrum of hepatocellular carcinoma, its correlation with serum alpha-fetoprotein level, and hepatitis B and C viral markers.

Fine-needle aspirationbiopsy (FNAB) is now widely accepted as a diagnostic modality for the treatment of hepatocellular carcinoma (HCC). The most common diagnostic problem in HCC is distinguishing it from a metastatic carcinoma. The literature from India on HCC is scanty. Hence, we studied the cytomorphological features of HCC and metastatic carcinoma. The study included 37 cases of space-occupying lesions (SOLs) of the liver as demonstrated by ultrasound or computed tomography (CT) scan. Cytomorphological features of these SOLs were analyzed in all subsequent to FNAB. Hepatitis B surface antigen (HBsAg), anti-hepatitis C virus antibody (anti-HCV) and alpha-fetoprotein (AFP) were determined in all the cases by enzyme-linked immunosorbent assay (ELISA). The cytopathological diagnosis was HCC in 22 and metastatic carcinoma of the liver in 15. The individual cytomorphological features and which helped to make a definite diagnosis of HCC were: a high nuclear cytoplasmic ratio (81.8%), predominantly trabecular pattern (63.6%) and atypical naked nuclei (100%). Other features were prominent multiple nucleoli (63.3%), hyperchromasia (100%) and moderate anisonucleosis (59%). AFP was elevated in 81.8% of the cases with a mean of 634.8+812.7 ng/ml. HBsAg by ELISA was found to be positive in 72.7% of cases while only 1 case (4.5%) was positive for anti-HCV. In 1 case (4.5%), there was dual infection due to hepatitis B virus (HBV) and HCV. No viral cause was found in 18.3% of cases.

Hepatitis C virus infection among Thai blood donors: antibody prevalence, risk factors and development of risk screening form.

Hepatitis C virus (HCV) infection is an important blood-borne infection in many countries, including Thailand. For epidemiological surveillance and controlling the infection, 2167 blood donors were screened for antibody to HCV by an enzyme immunoassay method and interviewed by using a structured questionnaire which consisted of personal health history and some risk behaviors. The prevalence and risk factors were assessed and the risk screening form was developed. The results revealed that the prevalence of anti-HCV was 2.90%. Male blood donors had relatively higher anti-HCV positive rate than females (3.21% vs 1.77%). The significant risk factors from univariate analysis were: (a) gender as male, OR = 1.94 (p = 0.042), (b) education to the primary level, OR = 4.15 (p < 0.001), (c) occupation as laborer or agriculture workers, OR = 2.87 (p < 0.001), police and military, OR = 1.82 (p = 0.046), (d) residence in a rural area, OR = 3.09 (p < 0.001), (e) a history of receiving blood or blood products, OR = 5.21 (p < 0.001), (f) a history of tattooing, OR = 1.70 (p = 0.043), (g) a history of IDU (Infecting Drug Use), OR = 41.43 (p < 0.001), (h) a history of STDs (sexually transmitted diseases) in the last year, OR = 3.87 (p = 0.021), and (i) a history of sexual service, OR = 4.24 (p = 0.017). After multivariate analysis, four variables related to HCV infection among the studied samples included education to the primary level, OR = 3.34 (p = 0.0036), occupation as a laborer or agriculture worker, OR = 2.14 (p = 0.0092), a history of receiving blood or blood products, OR = 4.13 (p = 0.0029), and a history of IDU, OR = 3.82 (p < 0.0001).The risk screening form was developed using risk scores. The validity was calculated by the Receiving Operating Curve. The sensitivity of this form was approximately 55.3% and the specificity was 85.7% when a cut-off score at risk > or =7 was used. If the cut-off score was > or =6, the screening form showed 77.1% of specificity and 61.3% sensitivity. This risk screening form should be applied not only for blood donation but also for pre-marital health screening.

Frequency of hepatitis C in obstertric cases

To compare the frequency of antihepatitis C virus [HCV] after single blood transfusion, multiple blood transfusion and in non-transfused obstetric cases. Design: A comparative descriptive study. Place and Duration of Study: The Department of Obstetric and Gynaecology, Jinnah Postgraduate Medical Centre, during the period of one-year from January 2002 to December 2002. Patients and Patients included in the study after single transfusion were 38, after multiple transfusion 39, and controls 120. History of patients regarding all the relevant information and clinical examination were recorded on a specially-designed and coded proforma. Anti-HCV was detected by Roche HCV EIA 2nd generation kit method in all cases and controls. Descriptive statistics and frequency of anti HCV in each group was calculated using SPSS version 10. Frequency of anti-HCV among patients with single blood transfusion was 13.2% [5], with multiple transfusion was 15.4% [6] and 6.6% [8] in non-transfused subjects. Anti-HCV frequency after one pint blood was almost same [13.2%] as after multiple transfusion [15.4%]. This positively provided a firm argument for the necessity of a nationwide blood donor screening for anti-HCV by most sensitive immunoassay. Equally important was the need for clear cut indication for single blood transfusion

Frequency and transmission mode of hepatitis C virus in Northern Sindh

To study the frequency of hepatitis C and mode of transmission in patients of chronic liver disease [CLD]. Design: A descriptive, non-interventional study. Place and Duration of Study: The study was conducted in the department of Medicine, Chandka Medical College Hospital, Larkana over a period of 6-year [January 1997-December 2002]. Patients and The study included 1074 patients of chronic liver disease admitted to the department of medicine due to HCV. Their variables were recorded and analyzed. A total of 1074 patients, comprising of 564 of chronic hepatitis [group I] and 510 of cirrhosis liver [group II] respectively were studied. The male to female ratio was 2:1 in both groups. Anti-HCV antibody was present in 51% in group I and 57% in group II. Use of syringes [62%] was an important risk factor. HCV is a leading cause of CLD. The leading risk factor identified is the use of contaminated syringes

Relative prevalence of hepatitis B viral markers and hepatitis C virus antibodies (anti HCV) in Madurai, south India.

(1) The positivity of HBsAg was 4% (75/1819) whereas anti HCV was present only in 0.75% (27/3574) of blood donors. (2) 5.3% (4/75) of hospital staff had HBsAg alone in their blood samples. One doctor, one Staff nurse, one Lascar and one Sanitary worker were positive for HBsAg. None of them were positive for anti HBcIgm and anti-HCV. (3) 29% (31/115) of suspected hepatitis cases were positive for any one of the viral markers or both. 21% (15/72) of males and 14% (6/43) of females were positive for HBsAg. Whereas only 4% (3/72) of males and 2% (1/43) of females were positive for anti HCW. Both HBsAg and anti HCV were found in 8% (6/72) of males only. The age group predominantly, i.e. in 29 out of 31 cases found positive for HBsAg and/or anti HCV, was above 15 years. Two remaining HBsAg positive cases belonged to the 5 to 14 years age group. 71% (84/115) of suspected hepatitis cases were negative for both HBsAg and anti HCV.

Seroepidemiology of hepatitis A in Delhi.

A prospective study was done to determine the age specific prevalence of antihepatitis A antibodies (anti HAV Abs) among children in Delhi. Four hundred and twenty children aged 0-12 years attending outpatient department for vaccination or any minor illness were studied. Sera was tested by ELISA for anti HAV Abs using a commercial kit (Hepvase A 96 TMB). Thirty samples of cord blood were similarly analyzed. All samples of cord blood were positive for anti HAV Abs. Prevalence of anti HAV Abs was 80% by 5 years of age. The most vulnerable age group was 0.5-1.5 years (anti HAV Ab positivity). Cord blood had 100% positivity. Univariate and multivariate analyses taking anti HAV antibody positivity as dependant variable demonstrated that age and father's education (socioeconomic status) significantly affect prevalence of anti HAV Abs. Sex, water supply, history of jaundice in self or family did not have any significant effect on anti HAV antibody positivity. Prevalence of anti HAV antibodies is 80% by 5 years of age. Further studies in different strata of society and different regions in the country are required to assess the need and age for vaccination.

Prevalence of hepatitis c antibodies and associated risk factors in blood donors in united arab emirates

There have been no published reports on the seroprevalence and risk factors for hepatitis C virus among blood donors in United Arab Emirates. This prospective study was conducted in Sharjah Central Blood Bank Blood donors [n=3588] were tested for anti-hepatitis C antibodies to estimate the seroprevalence rate of hepatitis C and some demographic characteristics were studied to identify the associated risk factors. The study showed that the overall prevalence rate of anti-HCV antibody in the studied group was 1.67% [60/3588] with a higher prevalence of 15.92% [25/157] in Egyptian donors. Exclusion of this group would reduce the prevalence to 1.02% [35/3431]. Prevalence rate in UAE nationals was 1.71% [13/759]. The associated risk factors identified in this study included age group 36-45 years, first time donors, unpaid donation and level of education of only secondary school

Antigenemia in chronic liver disease

To investigate the prevalence of HBsAg and Anti HCV antibodies in chronic liver disease [CLD] in a teaching hospital of Lahore. Design: A prospective study of 90 patients with cirrhosis and portal hypertension. This was a part of research for MD thesis. Setting: East Medical Ward, Department of Medicine, Mayo Hospital Lahore attached with King Edward Medical College, Lahore-Pakistan. Subjects: Ninety consecutive patients of cirrhosis with portal hypertension admitted to East Medical Ward from 1993-1994. Main Outcome Measures: Prevalence of viral markers as possible aetiological agents leading to hepatitis and cirrhosis. Fifty-nine patients [65.5%] had positive anti HCV antibodies, 22 patients [24.4%] had positive HBsAg whereas 22 patients [24.4%] were positive for both. The remaining 9 patients were negative for both HBsAg and anti HCV antibodies. All the patients with antigenemia had either history of injections or blood transfusions in the past, which might have led to viral transmission causing hepatitis and cirrhosis. Cirrhosis is on the rise in Pakistan and a very common health problem challenging the medical profession. Screening of blood donors and other preventive measures can help reduce the magnitude of the menace

Antibodies to hepatitis C virus and alanine amino-transferase in chronic liver disease

80 patients of chronic liver disease with 10 healthy controls were studied in the Microbiology Department, Basic Sciences Medical Institute, Jinnah Postgraduate Medical Center [BMSI, JPMC], Karachi. All patients were suffering from chronic liver disease i.e. chronic persistent hepatitis, chronic active hepatitis, cirrhosis of liver and hepatocellular carcinoma for more than six months duration. The alanine aminotransferase [ALT] was persistent / fluctuating raised [>40 IU/L for males and > 35 IU/L for females] for more than three months. Samples were collected from admitted patients of various hospitals of Karachi. Ten healthy individuals with normal ALT were also included in the study. The prevalence among chronic liver disease was found to be 40%. The prevalence with history of blood transfusion, parentral therapies, hemodialysis and with no known history of possible contact with the virus was found 45%, 45.6%, 100% and 28.7% respectively