Prevalence of silent hepatitis B and HCV genotype among chronic hepatitis C patients

ABSTRACT

This multi-center study was designed as a trial to explore the prevalence of silent hepatitis B infection among hepatitis C patients and to determine the prevalent genotype of hepatitis C virus [HCV] in these patients. The study comprised 45 patients with post-hepatitic liver cirrhosis. All patients gave blood samples for estimation of liver function tests, ELISA estimation of serum levels of hepatitis B surface antigen [HBsAg], anti-HCV antibodies and HCV core antigen, patients with HBsAg positive were excluded off the study. Qualitative detection of HCV RNA and HBV DNA by PCR [home-made PCR] and Quantitative PCR for estimation of HCV viremia and HCV genotyping by REFLP technique were performed. The HCV-Ab was detected in all and HCV-Ag in 42 samples [93.3%] irrespective of its clinical severity class with a mean viremia level of 792336.7 +/- 400074.8; range 134985-1957632 viral copy/ml as determined by quantitative PCR. There was a non-significant difference between severity clinical classes as regards the qualitative or quantitative detection of HCV infection. The HBV DNA was detected using qualitative PCR in 20 samples [44.4%]; 4 class A, 7 class B and 9 class C samples with a significant increase of the frequency of silent HB in patients with class B [X[2]=5.446, p<0.01] and C [X[2]=8.154, p<0.001] in comparison to class A patients. Genotyping of HCV reported 41 samples [91.1%] with genotype-4 and 4 samples [8.9%] with genotype-1 with a prevalence rate of HCV genotype-4 was 91.1%. There was positive non-significant correlation between both HCV genotype and the presence of silent hepatitis B infection and clinical severity, however, using the receiver operating characteristic [ROC] curve analysis judged by the area under the curve [AUC] to evaluate the sensitivity and specificity of detection of silent hepatitis B infection and identification of HCV genotype as predictors of severe hepatitis showed a non-specific role for genotyping for prediction of severity with AUC=0.467, while the detection of HBV DNA using PCR in patients with HCV infection is a specific predictor of severity with AUC=0.617. It could be concluded that HCV genotype-4 is the most prevalent type in Egyptian Hepatitis C cirrhotic patients with a prevalence of silent hepatitis B of 44.4% and its detection is a specific predictor of severe cirrhosis