Occult HCV or delayed viral clearance from lymphocytes of Chronic HCV genotype 3 patients after interferon therapy.

BACKGROUND: A recently discovered occult HCV entity reported by various investigators seems to be highly controversial. Especially, the clinical significance of these findings remains uncertain. For optimal outcome of antiviral therapy, investigation of occult HCV needs a broad-based probe in order to investigate the results of viral therapy and its host/viral interaction. The current study was aimed at determining the prevalence of occult HCV in peripheral blood lymphocytes of predominantly genotype 3 HCV-infected patients after completion of antiviral therapy and to investigate long term outcomes in the presence or absence of PBMC positivity. METHOD: A total of 151 chronic, antiHCV and serum RNA-positive patients were enrolled in the study. Patients with a complete virological response at the end of treatment were screened for the presence of viral RNA in their PBMCs and were followed for up to one year for the presence of serum and PBMC viral genomic RNA. RESULTS: Out of 151 patients, 104 (70%) responded to the prescribed interferon treatment and showed viral-clearance from serum. These were screened for the presence of genomic RNA in their PBMCs. Sixteen samples were PBMC-positive for viral RNA at the end of treatment (EOT). All these patients had also cleared the virus from peripheral blood cells after the 6-12 month follow-up study. CONCLUSION: True occult hepatitis C virus does not exist in our cohort. Residual viremia at the EOT stage merely reflects a difference in viral kinetics in various compartments that remains a target of immune response even after the end of antiviral therapy and is eventually cleared out at the sustained viral response (SVR).

Patient HLA-DRB1* and -DQB1* allele and haplotype association with hepatitis C virus persistence and clearance.

Hepatitis C virus (HCV) infection is prevalent throughout the world and interferon (IFN)-based treatments are currently the only therapeutic option. However, depending upon variations in their human leukocyte antigen (HLA), some patients do not respond well to IFN therapy. The current study evaluated the HLA allele and haplotype distribution of 204 HCV-seropositive individuals from Islamabad, Pakistan, who were receiving standard IFN therapy. In this cohort, 150 patients (74%) showed a sustained virological response to IFN therapy, whereas 54 (26%) did not. In addition to the HCV patients, 102 unrelated healthy volunteers were used as controls. DNA was isolated from the blood of the patients and controls for HLA-DRB1 and HLA-DQB1 allele typing, whilst plasma was used for HCV detection and genotyping. HLA-DRB1*04 was found to impart a significant protective advantage [Bonferroni-corrected P value (pc)=0.047] against HCV infection. In patients on IFN therapy, HLA-DRB1*11 and -DQB1*0301 (pc=0.044) were found to be associated with viral clearance. In contrast, HLA-DRB1*07 (pc=0.008) individually or in combination with HLA-DQB1*02 was found to be associated with viral persistence. These associations of HLA with HCV persistence or clearance will be beneficial in deciding the therapeutic regimen for Pakistani patients infected with HCV genotype 3a.

Prevalence of the C677T single-nucleotide polymorphism in the methylenetetrahydrofolate reductase gene among Pakistani ethnic groups.

Methylenetetrahydrofolate reductase is an important enzyme in metabolism of homocysteine, and a mutation in the gene predisposes individuals to several disorders related to homocysteine levels. Polymorphism at C677T shows marked heterogeneity based upon ethnicity and geographical location. Pakistani population consists of various ethnic groups confined to different regions of the country where congenital and genetic defects are a major health concern. We have analyzed the distribution of C677T alleles in different Pakistani ethnic groups. A cross-sectional study was conducted from all the four provinces of the country with samples representing the 14 different ethnic clans. A questionnaire with details of their ethnic origin was used, and informed consent was obtained. Blood samples from 701 individuals were collected for DNA isolation and subsequent C677T single-nucleotide polymorphism determination. The data were statistically analyzed. The study revealed that genotypic frequency for CC varied from 0.89 (Mohanna) to 0.38 (Hazara), CT from 0.56 (Hazara) to 0.11 (Mohanna), and TT from 0.06 to 0. Our data revealed a varied distribution of C677T mutation. This information could be helpful for designing future public health strategies, as it can be used to predict the prevalence of several disorders associated with genetic predisposition due to methylenetetrahydrofolate reductase C677T alleles.