Insulin resistance as a predictor of early virologic response to HCV therapy among chronic HCV Egyptian patients.

Prior assessment of insulin resistance by HOMA-IR is emerging as an important milestone in the treatment of patients with chronic hepatitis C. This cost-effective tool is recommended to individualize treatment duration, or to exclude those with low insulin sensitivity from being treated until ameliorating their state of insulin resistance (IR). The present work aims to elucidate further the effect IR state on early viral kinetic response to Chronic hepatitis C virus (HCV) therapy and the impact of HCV treatment and viral eradication on insulin sensitivity. Insulin sensitivity was assessed using the HOMA-IR method. All enrolled patients were treated with a dual therapy (pegylated interferon-alpha plus ribavirin) for 48 weeks and evaluated using qRT-PCR for early virologic response as well as the impact of treatment on insulin sensitivity throughout the early period of therapy. Of a total 392 chronic HCV cases, early virologic response was achieved by 318 (81.1%). IR was detected in 241 (61.5%) chronic HCV patient of which 73.4% responded to treatment. Early virologic response among patients with > 2.18 HOMA-IR value were significantly lower than those with HOMA-IR values ≤2.18 (P < 0.0001). IR was significantly associated with high baseline BMI. Steatosis and fibrosis correlated with IR but neither independently predicted early virologic response. Pretreatment IR < 2.18, low fasting blood glucose, low and intermediate HCV viral load, normal BMI, and non-smoking were independent factors associated with early virologic response. IR interferes with early virologic response to the antiviral care. Clinical application of pretreatment HOMA-IR assessment could help in predicting early treatment outcome and thus enable treatment regimens to be optimized and individually tailored.

Factors Associated with Hepatitis C Infection among Chronic HCV Egyptian Patients.

BACKGROUND: Identification of risk factors of acute hepatitis C virus (HCV) infection in Egypt is crucial for developing appropriate prevention strategies. There are few community-based studies on the epidemiology and risk factors of hepatitis C infection in Egypt, which could not provide enough information. Clear identification of past and current risk factors for infection is of utmost importance so that intervention programs can be appropriately focused. This study aims to provide up-to-date information about changes in the incidence of individual risk factors for HCV infection transmission in Egypt. METHODS: A total of 396 chronic HCV patients on follow-up treatment at liver center in El-Qabbary General Hospital in Alexandria were evaluated retrospectively regarding the potential iatrogenic, community acquired and behavioral HCV risk factors. Risk factors for HCV transmission were found in all study populations. RESULTS: At least three identifiable risk factors were reported by each participant. Some behavioral and community-acquired exposures that entail several risky behaviors particularly, unsafe sexual practices were exclusively established among males. We report a significant decline in prevalence of HCV transmission through blood transfusion, parenteral treatment, hospitalization, surgery, non medicalized circumcision, Hijiama done by informal practitioner, tattooing, folk body piercing and threading, sharing hygiene and sharp items, and the use of communal barber or manicure sets among younger age cluster. CONCLUSION: The pattern of risk differed among older patients compared to younger age group suggesting improved medical care and infection control measures and raised public health awareness regarding the different modes of viral transmission.

Circulating anti-HLA antibodies in patients with chronic hepatitis C: relation to disease activity.

The human leukocyte antigens (HLA) may influence host immune to infection. In the mean time chronic hepatitis C (CHC) results in the appearance of a variety of autoantibodies. We investigated the frequency of circulating anti-HLA antibodies and none organ specific autoantibodies in patients with chronic hepatitis C at different stages of disease activity. Sixty-seven untreated male patients with CHC (anti-HCV antibody and HCV RNA positive), in whom 38 had elevated serum alanine aminotransferase (ALT) levels and 29 persistently normal serum ALT values, and 23 age-matched normal male subjects were studied. None of them had a history of blood transfusion. Sera were analyzed for immunoglobulin G-anti-HLA class I and class II antibodies by enzyme-linked immunosorbant assay, and for non-organ-specific autoantibodies (antinuclear, anti-smooth muscle, anti-mitochondrial and anti-liver/kidney microsomes type 1 antibodies) using indirect immunofluorescence technique. Circulating anti-HLA class I and class II antibodies were detected in 15/67 (22.4 %) and 11/67 (16.4 %) respectively, while none of normal controls had detectable anti-HLA antibodies in the serum. The frequency of detecting anti-HLA antibodies was significantly higher in patients with elevated serum ALT than persistently normal serum ALT values (31.6 % vs 10.3 %; P = 0.039) and was associated with non-organ-specific serum autoantibodies in 11/15 (73.3 %) patients. Those with circulating anti-HLA antibodies had significantly higher levels of serum aminotransferases, gamma-glutamyl transpeptidase, viral load and necroinflammatory and fibrosis scores in liver biopsies than patients with negative anti-HLA antibody (P < 0.001). In conclusions, the presence of circulating antibodies against HLA class I and class II molecules in HCV antibodies may represent an autoimmune response to HLA antigens and may play a pathogenetic role in the induction of the HCV-related chronic liver disease.