IgG1 and IgG4 antibodies against core and NS3 antigens of hepatitis C virus

Abstract INTRODUCTION: IgG subclasses involved in the immune response to hepatitis C virus (HCV) antigens have been rarely studied. We investigated the immune response mediated by IgG1 and IgG4 antibodies against the recombinant core and NS3 antigens in patients with chronic hepatitis C. METHODS: Sixty patients infected with HCV genotype 1 without antiviral treatment and 60 healthy subjects participated in the study. Serum levels of alanine aminotransferase, HCV viremia, and the presence of cryoglobulinemia and liver fibrosis were determined. We investigated the serum IgG1 and IgG4 antibodies against recombinant HCV core and NS3 non-structural protein antigens using amplified indirect ELISA. RESULTS: Anti-core and anti-NS3 IgG1 antibodies were detected in 33/60 (55%) and 46/60 (77%) patients, respectively, whereas only two healthy control samples reacted with an antigen (NS3). Anti-core IgG4 antibodies were not detected in either group, while 30/60 (50%) patients had anti-NS3 IgG4 antibodies. Even though there were higher levels of anti-NS3 IgG4 antibodies in patients with low viremia (< 8 × 105 IU/mL), IgG1 and IgG4 antibody levels did not correlate with ALT levels, the presence of cryoglobulinemia, or degree of hepatic fibrosis. High production of anti-core and anti-NS3 IgG1 antibodies was observed in chronic hepatitis C patients. In contrast, IgG4 antibodies seemed to only be produced against the NS3 non-structural antigen and appeared to be involved in viremia control. CONCLUSIONS: IgG1 antibodies against structural and non-structural antigens can be detected in chronic hepatitis C, while IgG4 antibodies seem to be selectively stimulated by non-structural HCV proteins, such as the NS3 antigen.

Correlation between hepatitis C viral load and hepatitis C Core antigenaemia among Egyptians

Hepatitis C virus [HCV] infection is widespread in Egypt. This study compared HCV RNA with HCVcAg for the detection and quantification of viraemia among a sample of Egyptians. Sera from 80 suspected HCV-positive individuals were tested simultaneously for HCV-RNA load using real-time polymerase chain reaction [PCR] and HCVcAg level using ELISA. Of the 80 samples, 25% were HCV-RNA-negative. HCVcAg was detected in all samples: range 0.4-2462 ng/mL, mean 460 [SD 506] ng/mL. The sensitivity and specificity of HCVcAg were 96.7% and 90.9%, respectively. There was a significant correlation between serum HCV-RNA and HCVcAg levels [r = 0.4, P < 0.0001]. HCV-RNA remains the gold standard for diagnosis of active HCV infection but HCVcAg can be used where PCR is not available

Occult hepatitis B infection in Egyptian health care workers

We tested the frequency of occult hepatitis B infection [OBI] among Egyptian healthcare workers [HCWs]. We tested 132 HCWs for hepatitis B virus [HBV] DNA by nested polymerase chain reaction [PCR], and hepatitis C virus antibody [anti-HCV] by ELISA. HCV RNA was measured by nested PCR in anti-HCV-positive HCWs. HBV-DNA-positive HCWs were subjected to HBV genotyping. We included 132 HCWs who were negative for hepatitis B surface antigen and positive for hepatitis B core antibody [anti-HBc]. OBI was detected in 7 male HCWs, and HBV E genotype was detected in 3, HBV D in 2 and HBV D and E in 2. Two OBI-positive HCWs had a history of neonatal hepatitis B vaccination. Anti-HCV seropositivity was detected in 17 HCWs who were positive for anti-HBc; 15 of whom were positive for HCV RNA by nested PCR. HCV infection was confirmed by anti-HCV and HCV RNA in 1 of 7 HCWs with OBI. In conclusion, Egyptian HCWs have a significant rate of OBI and HBV E genotype is prevalent

Association of genotypes with viral load and biochemical markers in HCV-infected Sindhi patients

Abstract The presented study had two objectives. The first was to examine distributions of Hepatitis C Virus (HCV) genotypes in Sindh, Pakistan, where HCV is prevalent. The other was to explore clinically relevant relationships between the genotypes, viral load (measured by real-time polymerase chain reaction assays) and biochemical markers. For this, 1471 HCV-infected patients in six cities in Sindh were recruited and sampled. HCV genotype distributions varied among the cities, but genotype 3a was most prevalent, followed by 3b, 1a and 1b (detected in 51.5, 22.7. 9.25 and 3.2% of the cases, respectively). No type-specific sequences were detected in serum samples from 189 (12.8%) of the 1471 patients. Frequencies of low (<200,000 IU/mL serum), intermediate (200,000-600,000 IU/mL serum) and high (>600,000 IU/mL serum) viral loads were respectively 45.4, 16.5 and 38.1% for patients infected with genotype 3, and 16.9, 36.9 and 46.2%, respectively, for patients with other genotypes. Infection with genotype 1a was associated with significantly higher (p < 0.005) alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase titers than infection with genotype 3a. The results will help in the formulation of treatment strategies.

Hepatitis C in prisoners and non-prisoners in Colatina, Espírito Santo, Brazil

The aim of the present work was to compare hepatitis C prevalence, genotypes, and risk factors between prisoners and non-prisoners in the city of Colatina, Espírito Santo, Brazil. This cross-sectional study involved approximately 1,600 residents and 730 prisoners, all of whom were living in Colatina. The percentage of individuals who tested positive for anti-HCV was 0.1% (2/1,600) in the non-prisoner group and 1.0% (7/730) in the prisoner group, confirming a higher risk of hepatitis C in the latter group. The percentage of subjects who progressed to HCV-RNA negative was 11.1% (1/9), confirming the high probability of evolution to chronicity. Genotype 1 was the most predominant genotype found. Factors associated with increased risk of hepatitis C were being male, being institutionalized, having an income of less than three minimum wages, having low educational attainment, and using injected drugs. Alcohol use, pain in the liver, migraine, and reported history of hepatitis were markedly associated with hepatitis C. The prison population tested positive for anti-HCV at a higher rate than the non-prison population.

O objetivo do presente trabalho foi comparar a prevalência, os genótipos e fatores de risco da hepatite C entre a população em geral e os presos na cidade de Colatina, Espírito Santo, Brasil. O presente estudo é transversal e comparou cerca de 1.600 moradores e 730 prisioneiros, todos eles vivendo em Colatina. A prevalência de anticorpos anti-HCV positivo foi de 0,1% (2/1.600), na população em geral, e de 1,0% (7/730) entre os presos, o que confirma o elevado risco nesse grupo. A percentagem de indivíduos que apresentam RNA-HCV negativo foi de 11,1% (1/9), confirmando a alta taxa de evolução para a cronicidade. O genótipo predominante foi o I. Fatores associados ao aumento do risco de hepatite C foram do sexo masculino, sendo institucionalizado, com renda de até três salários mínimos, baixa escolaridade e uso de drogas injetáveis. O uso de álcool, dor no fígado, enxaqueca e relato de histórias de hepatite apresentaram associação significativa com a hepatite C. A população carcerária teve maiores taxas de positividade para o anti-HCV do que a população não-prisional pesquisada.

Implicancia del polimorfismo de IL28B en la infección por el virus de la Hepatitis C / Role of IL28B ppolymorphism in Hepatitis C infection

La evolución de la infección por HCV está influenciada por factores del virus y del hospedador. Entre los que atañen al virus, el genotipo es el principal factor predictivo basal de la respuesta virológica sostenida. En cuanto al hospedador, recientemente tres grupos independientes identificaron, mediante estudios de asociación genómica amplia (GWAS), una correlación entre el polimorfismo rs12979860 cercano al locus de la interleuquina 28B y la respuesta virológica sostenida. Esta contribución es sustancial en pacientes infectados por HCV-1/4; mientras que en infecciones con HCV-2/3, que usualmente son las más exitosas per se, la ventaja conferida por el polimorfismo es exigua. Por otra parte, en pacientes HIV/HCV co-infectados la contribución del polimorfismo es similar a la observada en pacientes HCV mono-infectados. La determinación del polimorfismo de IL28B conjuntamente con el genotipo de HCV podría ser de utilización del tratamiento anti-HCV

The likelihood of attaining a sustained virological response in patients with chronic HCV infection depends on viral and host related factores. Among those related to the virus, the genotype is the strongest basal predictor of sustained virological response. As regards host factores three independent studies recently identified, through genome-wide association study (GWAS), a relationship between the rs12979860 single nucleotide polymorphisms near the interleukin 28B locus and the sustained virological reponse. This contribution had been proven in HCV-1/4 infected patients; whereas, in HCV-2/3 infections, usually the most successful treated, the advantage conferred by the polymorphism was limited. In addition, in HIV/HCV co-infections the contribution fof IL28B polymorphism is similar to that observed in HCV mono-infected patients. used in conjunction with HCV genotype, IL28B rs12979860 polymorphism may provide addional discriminatory power to identify kikely responders to treatment. These findings sugest the possibility of personalized medicine for the treatmet of this desease

Avaliação da utilização do teste immunoblot recombinante (RIBA) no diagnóstico da infecção pelo vírus da hepatite c (VHC) em doadores de sangue com anti-VHC reagente / Evaluation of the use of recombinant immunoblot test (RIBA) in the diagnosis of infection with hepatitis C virus (HCV) in blood donors with anti-HCV reagent

A infecção pelo vírus da hepatite C (VHC) é comumente assintomática e apresenta uma elevada taxa de cronicidade, podendo evoluir para cirrose e carcinoma hepatocelular. O diagnóstico da hepatite C é realizado através da pesquisa de anticorpos pelo teste de ELISA (Enzyme Linked Immunosorbent Assay) e confirmado por testes suplementares, tais como o RIBA (Recombinant Immunoblot Assay) e westernblot e teste confirmatório, como a pesquisa do VHC-RNA. O objetivo deste trabalho foi avaliar a eficácia do RIBA no diagnóstico da infecção pelo VHC em doadores de sangue com anti-VHC reagente. Foram analisadas 102 amostras com resultado de anti-VHC reagente naEMOBA, utilizando-se o teste anti-VHC Architect Abbott por quimioluminescência para detecção dos anticorpos anti-VHC, o RIBA III (CHIRON) como teste suplementar para as amostras anti-VHC reagentes e indeterminadas e a Reação em Cadeia da Polimerase (RT-PCR) convencional ou em tempo real (Amplicor Roche) para detecção do VHC- NA. As amostras com VHC-RNA detectável foram genotipadas por hibridização reversa (LIPA; SIEMENS). Das 102 amostras analisadas no LACEN, 38,2% (39/102) foram reagentes, 57,8% (59/102) foram não reagentes e 3,9% (4/102) foram indeterminadas para o anti-VHC. Os resultados do RIBA foram 58,1% (25/43) positivos, 9,3% (4/43) negativos e 32,6% (14/43) indeterminados. Todas as amostras com resultado de RIBA indeterminado tiveram carga viral indetectável. As bandas predominantes nas amostras indeterminadas foram c33 e c22. Das amostras indeterminadas no RIBA, repetidas após seis meses com nova coleta, 20% (2/10) negativaram e 71,4% (10/14) permaneceram RIBA indeterminado. Destas, (8/10) continuaram indeterminadas com o mesmo padrão de bandas. O VHC-RNA foi realizado em todas as amostras do estudo (102) e foi detectável em apenas 22,5% (23/102). Todas as amostras com VHC-RNA detectável foram RIBA positivo e tinham índex maior que cinco na relação S/CO. Em apenas duas amostras que tiveram resultado de RIBA positivo, o VHC-RNA não foi detectado. As 23 amostras com VHC-RNA detectável foram genotipadas, sendo 78,3% (18/23) do genótipo 1, 17,4% (4/23) do genótipo 3 e 4,3% (1/23) do genótipo 2. A positividade do anti-VHC associou-se com o uso de droga intranasal (< 0,001), com drogas injetáveis (< 0,001)) e ocorrência de DST (< 0,05). Diante dos resultados encontrados, observa-se que o RIBA apresenta um elevado número de resultados indeterminados, sendo necessária a realização do VHC-RNA para a confirmação da infecção pelo VHC. Indivíduos com resultado de anti-VHC índex menor que cinco e resultado de RIBA indeterminado têm grande probabilidade de não apresentarem o VHC-RNA detectável e portanto, de não estarem infectados pelo VHC, mas devem ser acompanhados sorologicamente, de acordo com o critério médico.

Prevalence of HIV, syphilis, hepatitis B and C among adults with mental illness: a multicenter study in Brazil / Prevalência de HIV, sífilis, hepatites B e C entre adultos com transtornos mentais: um estudo multicêntrico no Brasil

OBJECTIVE: There is evidence that patients with mental illness have increased prevalence of sexually transmitted infections, but data in Brazil are scarce. The objective of this study was to determine the prevalence of HIV, hepatitis C and B, and syphilis among patients with mental illness in Brazil. METHOD: A multicenter representative sample of adults with mental illness was randomly selected from 26 mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Seroprevalence with 95 percent confidence limits were obtained correcting for sampling scheme. RESULTS: Of the 2,475 patients interviewed, 2,238 had blood collected. Most participants were sexually active ever (88.8 percent) or in the last 6 months (61.6 percent), female (51.9 percent), and single (66.6 percent). Half of the sample had less than 5 years of schooling and the mean monthly individual income was low (US$ 210.00). Condom use was very low either during lifetime (8 percent) or in the last 6 months (16 percent). Overall seroprevalence were 1.12 percent, 0.80 percent, 1.64 percent, 14.7 percent and 2.63 percent for, respectively, syphilis, HIV, HBsAg, anti-HBc and anti-HCV. CONCLUSIONS: Seroprevalences found were higher than other populations with representative studies in Brazil, with high rates of sexual risk behavior. This is of public health concern, and prevention and care strategies for sexually transmitted infections among psychiatric patients should urgently be implemented by health authorities.

OBJETIVO: Evidências indicam que pacientes com transtornos mentais têm elevada prevalência de infecções sexualmente transmissíveis, mas dados brasileiros são escassos. O objetivo deste estudo foi determinar a prevalência do HIV, hepatites C e B, e sífilis entre pacientes com transtornos mentais no Brasil. MÉTODO: Uma amostra representativa de pacientes adultos com transtornos mentais foi aleatoriamente selecionada de instituições públicas de saúde mental no Brasil. Dados sociodemográficos, comportamentais e clínicos foram obtidos por entrevista face-a-face e sangue foi coletado para exames sorológicos. Soroprevalências com intervalo de 95 por cento de confiança foram obtidas com correção para o esquema amostral. RESULTADOS: Dos 2.475 pacientes entrevistados, 2.238 tiveram sangue coletado. A maioria era sexualmente ativa ao longo da vida (88,8 por cento) ou nos últimos seis meses (61,4 por cento), do gênero feminino (51,9 por cento), solteira (66,6 por cento), com metade dos participantes com menos de cinco anos de escolaridade e renda média mensal baixa individual (US$210). Uso de preservativo foi baixo em toda a vida (8 por cento) ou nos últimos seis (16 por cento). As soroprevalências gerais foram 1,12 por cento, 0,80 por cento, 1,64 por cento, 14,7 por cento e 2,63 por cento para, respectivamente, sífilis, HIV, HBsAg, anti-HBc e anti-HCV. CONCLUSÕES: As soroprevalências encontradas são maiores do que outros estudos com populações representativas no Brasil, com altos índices de comportamento sexual de risco. Isto é preocupante e estratégias de prevenção e cuidado para as infecções sexualmente transmissíveis entre pacientes psiquiátricos devem ser urgentemente implementadas pelos serviços de saúde.

Evaluación de un nuevo inmunoensayo para detectar anticuerpos contra el virus de la hepatitis C / Evaluation of new immunoassay for detection of antibodies against hepatitis C virus

Se evaluó el desempeño de un nuevo inmunoensayo de tercera generación para la detección de anticuerpos contra el virus de la Hepatitis C, HCV ELISA 3ª generación (Wiener-lab. Rosario. Argentina). Este equipo presenta reactivos coloreados para permitir el monitoreo de adición de muestras y control de procesos. Se evaluó la sensibilidad, especificidad y precisión de HCV ELISA 3ª generación mediante 5 paneles de seroconversión, 8 paneles de desempeño, 1 panel de sensibilidad para diferentes genotipos de HCV, 23 muestras de pacientes infectados con diferentes genotipos de HCV, 546 muestras de pacientes infectados, 556 muestras que contenían interferentes potenciales y 3.024 muestras de individuos no infectados. La sensibilidad en paneles de desempeño y en pacientes infectados fue 99,72%, y en muestras de pacientes infectados con diferentes genotipos fue 100%. La especificidad obtenida en muestras de donantes de sangre y Centros de Salud fue 99,50%. Finalmente, en los estudios de precisión se observó un coeficiente de variación intraensayo menor al 10%, e interensayo menor al 15% para muestras reactivas débiles. HCV ELISA 3ª generación, desarrollado por Wiener-lab, presenta un desempeño adecuado para el diagnóstico de la infección por HCV en el laboratorio serológico y en el tamizaje de donantes de sangre.

The performance of a new third-generation Anti-HCV, HCV ELISA third-generation (Wiener-lab. Rosario. Argentina), was evaluated. This kit presents sample addition monitoring and process control. Sensibility, specificity and precision of HCV ELISA 3ª generation were evaluated by means of 5 seroconversion panels, 8 performance panels, 1 worldwide HCV performance panel (which includes different HCV genotypes), on 546 samples of patients infected with HCV, 556 samples containing potentially interfering substances, and 3024 samples of persons not infected with HCV. Sensibility was 99.72% on performance panels and samples of HCV infected patients, and 100% on samples of patients infected with different genotypes. The specificity obtained from samples from blood donors and health centers was 99.50%. Finally, in precision studies the intra-assay coefficient of variation found was smaller than 10% and the inter-assay CV was smaller than 15% for weak reactive samples. In summary, HCV ELISA 3ª generation developed by Wiener-lab presents an adequate performance for the diagnosis of hepatitis C virus infection in clinical laboratory and blood donations screening.

Autoanticuerpos tisulares y factor reumatoideo en la infección crónica por virus de la hepatitis C / Tissue autoantibodies and rheumatoid factor in the chronic hepatitis C virus infection

El objetivo de este estudio fue determinar la prevalencia de autoanticuerpos titulares y de factor reumatoideo (FR) en la infección crónica por Virus de la Hepatitis C (VHC) y su relación con el genotipo viral y tratamiento antiviral. Este estudio incluyó a 21 pacientes infectados con VHC y 24 sujetos sanos. Los autoanticuerpos: antinucleares (ANA), anti-músculo liso (ASMA), anti-mitocondriales (AMA) y anti-microsomales de hígado y riñón-1 (LKM-1) fueron investigados por inmunofluorescencia indirecta y el FR por aglutinación de látex. ANA fueron detectados en el 43% de pacientes y en el 4% de controles (p<0,05). ASMA, AMA Y LKM-1 no se detectaron en pacientes ni en controles. El FR estuvo presente en el 48% de los pacientes, pero en ninguno de los controles. En pacientes ANA (+) y/o FR (+), el nivel de la enzima alanina-aminotransferasa fue similar al nivel detectado en pacientes ANA y FR negativos. Además, la presencia de ANA o FR no estuvo asociada con el genotipo viral o tratamiento antiviral. En conclusión, una alta prevalencia de ANA y FR a títulos bajos pueden ser detectados en la infección crónica por VHC. Estas manifestaciones autoinmunes no están relacionadas con signos bioquímicos de daño hepático, ni genotipo viral o tratamiento antiviral.

The aim of this study was to determine the prevalence of tissue autoantibodies and rheumatoid factor (RF) in patients with chronic hepatitis C virus (HCV) infection and their relationship with viral genotype and antiviral treatment. This study included 21 patients infected with HCV and 24 healthy subjects. Anti-nuclear (ANA), anti-smooth muscle (SMA), anti-mitochondrial (AMA) and anti-liver-kidney microsomal-1 (LKM-1) autoantibodies were investigated by indirect immunofluorescence technique, and RF by latex agglutination. ANA were found in 43% of the patients with HCV infection and 4% of the controls (p<0.05). SMA, AMA and LKM-1 were absent from both groups (patients and controls). RF was detected in 48% of the patients but none of the controls. The level of serum alanine aminotransferasa enzyme was similar in all the patients' positive or negative results for ANA and/ or RF. Furthermore, the presence of ANA or RF was not associated with viral genotype or antiviral treatment. In conclusion, a high prevalence of ANA and RF at low titre can be detected in patients with HCV chronic infection. These autoimmune manifestations are not related with biochemical findings of hepatic injury, nor with genotype or antiviral treatment.

Estudo da resposta imune na infecção pelo vírus da hepatite C (VHC) / Study of immune response in infection by hepatitis C virus (HCV)

Os mecanismos da resposta imune que ocorrem na infecção pelo VHC em humanos ainda não estão totalmente esclarecidos. O objetivo deste trabalho foi caracterizar a resposta imune em doadores de sangue soropositivos para o VHC (VHC+), não virêmicos e virêmicos e comparar os resultados com aqueles observados no grupo controle de não infectados (NI). As citocinas foram dosadas no soro pelo Kit CBA (cytometric bead array; BD) e os marcadores de superfície celular foram determinados nas células mononucleares do sangue periférico por análise de citometria de fluxo. Foram observadas freqüências aumentadas de altos produtores de IL-113 e IL-B no grupo não virêmico, enquanto um aumento nas freqüências de altos produtores de IL-5, IL-10 e IL-12 foi observado no grupo virêmico. Houve um aumento seletivo na freqüência de altos produtores de IL-113 no subgrupo dos não virêmicos com teste confirmatório para o anti-VHC (R/BA) indeterminado, enquanto um aumento na freqüência de altos produtores para IL-B foi restrito ao subgrupo dos não virêmicos com RIBA positivo. Este mesmo subgrupo também apresentou além do aumento na freqüência de altos produtores para a IL-4, freqüências aumentadas de altos produtores de IL-6, IL-10 e IL-12, como no grupo virêmico. No grupo virêmico foi demonstrado um aumento dos níveis de IL-113, IL-B e TNF-a nos indivíduos com valores baixos de alanina-aminotransferases (AL T), enquanto níveis mais altos de IL-2 e IFN-y foram observados naqueles com valores elevados de AL T. Além disso, foram observados níveis aumentados de IL-6, IL-10 e IL-12 particularmente naqueles com carga viral baixa. Apesar de não haver modificações no perfil hematológico nos dois grupos estudados, níveis aumentados de células pré-NK (CD3-CD16+CD56-), diminuição das células NK maduras (CD3-CD16+CD56+) e aumento da freqüência de células T CD4+ ativadas (CD4+HLA-DR+) foram características da imunidade inata no grupo não virêmico. Apesar de ambos os grupos, virêmico e não virêmico, apresentarem altos percentuais de células NK CD56 Brigh esta população foi particularmente mais elevada no subgrupo dos virêmicos com carga viral baixa. O aumento do percentual de células B (CD19+) e de células CD19+CDB6+ foram as principais características do grupo virêmico, especialmente naqueles apresentando carga viral baixa. Apesar das células CD4+CD25High estarem elevadas em ambos os grupos VHC+, o aumento desta subpopulação de células T regulatórias (Treg) foi predominantemente observado no grupo virêmico que apresentava baixa carga viral. Nossos resultados sugerem que as citocinas pró-inflamatórias (IL-II3/IL-8/TNF -a), relacionadas principalmente com a resposta imune inata, estejam associadas com o início da infecção pelo VHC ou com uma infecção menos grave, enquanto as citocinas IL-2 e IFN-y, associadas com o perfil de imunidade adaptativa citotóxica, devem estar mais ligadas com o aumento de AL T, biomarcador de lesão hepática. Além disso, as células NK CD56 Bright, juntamente com as células pré-NK e células TCD4+ ativadas em paralelo com as células T regulatórias, podem ter um papel importante no controle da viremia na infecção pelo VHC. O aumento das respostas de células NK CD56Bright e de células B em paralelo com as células T regulatórias parece estar associada com a baixa carga viral.

Seroprevalence of HCV antibody among patients with B-Thalassemia major in amirkola thalassemia center, Iran

Beta- thalassemia major is a common hemoglobinopathy in humans. In some journals, numerous studies have reported different prevalence of hepatitis C among beta-thalassemia major because thalassemic patients need multiple blood transfusions and blood transfusion is a common transmission pathway for hepatitis C virus. Thus this study was performed for detection of anti-HCV between beta- thalassemia major patients in our region

Evaluation of five screening tests licensed in Argentina for detection of hepatitis C virus antibodies

This study was conducted to compare among the most recent generation of five screening tests licensed in Argentina, in order to evaluate which of the tests has the best sensitivity for detection of antibodies against hepatitis C virus (HCV). The tests analyzed were: Detect-HCV™ (3.0) Biochem ImmunoSystems, Canada; Hepatitis C EIA Wiener Lab., Argentina; Equipar HCV Ab, Italy; Murex HCV 4.0, UK and Serodia-HCV particles agglutination test, Japan. The results obtained showed high discrepancy between the different kits used and show that some of the tests assessed have a low sensitivity for anti-HCV detection in both chronic infections and early seroconversion, and indicate that among the commercially available kits in Argentina, Murex HCV 4.0 (UK) and Serodia-HCV particles agglutination test (Japan) have the best sensitivity for HCV screening. Although the sensitivity of the assays is the first parameter to be considered for blood screening, more studies should be carried out to assess the specificity of such assays.

Risk factors for hepatitis C virus infection in patients on long-trem hemodialysis

To estimate the frequency of hepatitis C virus [HCV] infection in patients on hemodialysis at Shifa International Hospital and determine the association of various risk factors in the acquisition of hepatitis C infection. A cross-sectional analytical study. Shifa International Hospital from January 2002 to June 2003. All patients on long-term hemodialysis in Nephrology Unit of Shifa International Hospital were studied. Their medical records were reviewed for the presence of anti-HCV in all patients. Any risk factors were noted from the patient's records and from the history of those patients who were regularly attending the dialysis unit. A total of 97 patients on hemodialysis were included. Out of these, 23 [23.7%] were found to be anti-HCV positive. The mean age of HCV positive patients was 55.2 +/- 15.5 years while for the anti-HCV negative patients it was 54.9 +/- 15.1 years. There were 18 [78.3%] males in the HCV positive group while 46 [62.2%] males in the HCV negative group. The mean duration of dialysis among HCV positive patients was 2.9 +/- 2.7 years while the mean duration of dialysis in HCV negative patients was 1.51 +/- 0.86 years [p-value 0.000]. Anti-HCV positive group had significantly greater proportion of patients with a history of dialysis more than 2 years [43.5% vs 9.5%], adjusted odds ratio being 0.45 [95% CI 0.27-0.75]. No significant difference in other risk factors between the two groups was found. When years of dialysis were treated as categorical variable, significant difference between the anti-HCV positive and negative groups was found. The risk of getting HCV was found to be significantly associated with increasing years of dialysis, [adjusted p-value 0.002]. Patients on hemodialysis in our unit had 23.7% positivity of anti-HCV and history of dialysis over more than 2 years was noted to be a significant risk factor for acquisition of infection in these patients

Fulminant hepatic failure: etiology, viral markers and outcome.

OBJECTIVE: To investigate the etiology and outcome of fulminant hepatic failure (FHF) in children. SETTING: Hospital based descriptive. METHODS: 36 children (22 males and 14 females) presenting with FHF over a period of one year were investigated. The ages ranged from 1.5 to 9 years. FHF was defined as occurrence of encephalopathy within eight weeks of onset of jaundice with no evidence of pre-existing liver disease. Detailed history, clinical examination, routine biochemical parameters and relevant diagnostic tests were carried out. Viral markers studied were anti HAV-IgM, HBsAg, anti HBc-IgM, anti-HCV and anti HEV-IgM. RESULTS: A viral etiology could be established in 22 children (61.1%). Hepatitis A (n = 12), Hepatitis B (n = 3), Hepatitis A and B (n = 2), and Hepatitis A and E (n = 4). Two children had enteric fever (1 with associated HEV), 2 children had Wilson's disease, 1 child had Indian Childhood Cirrhosis (ICC) and 2 children had drug induced hepatitis. Etiological diagnosis was not possible in 8 children (22%). Fourteen children (39%) died. Poor outcome was associated with spontaneous bleeding, raised prothrombin time, lower transaminases and higher bilirubin on admission. CONCLUSION: Viral hepatitis is the commonest cause of FHF in children. HAV alone or in combination is responsible for upto 50% of all FHF in children. Chronic liver disease can also present as FHF. Etiological diagnosis is not possible to upto one-fourth of all cases.

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

Monitoring antibody titers to recombinant Core-NS3 fusion polypeptide is useful for evaluating hepatitis C virus infection and responses to interferon-alpha therapy

To evaluate the clinical feasibility of the antibody titer against a chimeric polypeptide (named Core 518), in which a domain of Core and NS3 of hepatitis C virus (HCV) was fused, ELISA was performed in a total of 76 serum samples. Each serum was serially diluted using two-fold dilution method with distilled water into 10 concentrations. They were all positive for second generation anti-HCV assay (HCV EIA II; Abbott Laboratories). Genotyping RT-PCR, quantitative competitive RT-PCR, and RIBA (Lucky Confirm; LG Biotech) were also assayed. Anti-Core 518 antibody was detected in x 12800 or higher dilutions of sera from 35 of 43 chronic hepatitis C (81.4%) and nine of 16 hepatocellular carcinoma sera (56.3%), one of four cirrhosis (25%), 0 of four acute hepatitis C, and one of nine healthy isolated anti-HCV-positive subjects (p=0.0000). The anti-Core 518 antibody titers were well correlated with the presence of HCV RNA in serum (p=0.002). The anti-Core 518 antibody titers decreased significantly in nine of ten responders to IFN-alpha treatment. Monitoring anti-Core 518 titers may be helpful not only for differentiating the status of HCV infection among patients with various type C viral liver diseases, but also for predicting responses to IFN-alpha treatment.

Elevated alanine aminotransferase (ALT) in blood donors: an assessment of the main associated conditions and its relationship to the development of hepatitis C

A determinacao dos niveis de alanina aminotransferase (ALT) tem sido util para o diagnostico de hepatopatias. Ultimamente, a elevacao dos niveis sericos de ALT em doadores de sangue, tem sido associada a um maior risco de hepatites pos-tranfusionais. Este estudo busca identificar os fatores associados com elevados niveis de ALT entre doadores voluntarios de sangue e avaliar as relacoes entre estes aumentos de ALT e o desenvolvimento de infeccao pelo virus da hepatite C. Assim, 116 doadores voluntarios de sangue com niveis de ALT elevados, quando da primeira doacao, foram estudados. Todos foram questionados sobre hepatopatias previas, exposicao a hepatites, exposicao a produtos quimicos, uso de drogas ou medicamentos, comportamento sexual, contacto com sangue ou secrecoes e consumo de alcool...

Does schistosomiasis play a role in the high sero prevalence of HCV antibody among Egyptians?

Many studies have demonstrated a very high prevalence of HCV antibodies among blood donors (BD) and chronic liver disease (CLD) patients in Egypt. This high prevalence might be attributed to cross reactivity between HCV antibodies and schistosome antibodies. We decided to study the association and cross serology between the presence of anti-HCV and Schistosomal infection among BD and CLD patients. Sera of blood donors and CLD patients were tested for anti-HCV by second generation ELISA. Antibodies to Schistosoma species were quantified by IHA test. Two tailed z score was used to detect significant difference. To test for cross reactivity between the two antibodies 20 BD and 20 CLD patients positive for both HCV-antibody and schistosome antibody were taken as controls. Another 20 samples also served as a control group; 10 of them seropositive for HCV only and 10 positive for IHA for schistosomiasis alone. All were subjected to: 1) RIBA-2 confirmatory test 2) Adsorption of schistosome antibodies using 100 microgram schistosome antigens per 100 microliters serum 3) Both HCV-ELISA-2 and RIBA-2 were checked after adsorption. The titre of schistosome antibodies in positive sera ranged from 1:128 to 1:1536. HCV seroprevalence was more pronounced among antischistosomal positive sera. This was seen in both BD and CLD patients where antischistosomal positive sera were at double risk to show positive HCV antibody. After adsorption of schistosome antibody, there was no change in reactivity of both ELISA-2 and RIBA-2. We conclude that HCV antibodies were significantly higher in schistosomal antibody positive Egyptians, there was no cross reactivity between the two antibodies and the high prevalence could be due to HCV transmission during anti-bilharzial parenteral therapy or due to depressed cell mediated immunity associated with schistosomal infection.

Prevalência de anticorpos anti-vírus da Hepatite C e hemodiálise crônica / Prevalence of anti-HCV antibodies in chronic hemodialysis patients

Com o objetivo de determinar a prevalência de anticorpos anti-HCV e os fatores associados à infecçäo, foram avaliados, através de testes ELISA de terceira geraçäo, 20 pacientes em tratamento hemodialítico crônico e 20.209 doadores de sangue. Dos pacientes em hemodiálise (HD), 10 (50 por cento) apresentaram anticorpos anti-HCV e em 254 doadores de sangue (1,26 por cento) o teste foi positivo. Encontrou-se uma correlaçäo estatisticamente significativa entre o tempo de tratamento hemodialítico, o número de transfusöes sanguíneas e a positividade para o anti-HCV. Sexo, idade, HbsAg, etiologia da insuficiência renal crônica, condiçöes sócio-econômico-culturais, uso de drogas endovenosas e promiscuidade sexual näo apresentaram relaçäo significativa com a presença do anti-HCV. Conclui-se que há uma elevada prevalência de anticorpos anti-HCV nos pacientes em hemodiálise crônica. A presença de infecçäo pelo vírus C parece estar associada a um prolongado tempo de tratamento hemodialítico e a um elevado número de transfusöes sanguíneas