The role of the laboratory in the diagnosis and management of chronic hepatitis C patients.

Clinical diagnosis of chronic hepatitis C infections is a difficult task. This is due to the insidious nature of the infection and the subclinical and symptomless presentation in the majority of cases. The laboratory plays a principal role not only in the specific diagnosis of the infection but also in assessing the severity and evolution of the liver disease, selection of patients for therapeutic intervention, monitoring treatment and determining the outcome of treatment. To attain these goals, improvements in sensitivity and specificity of various techniques, including molecular diagnostic assays, have been introduced. Most importantly, patients may be excluded if they have conditions that are contra-indicated for treatment as determined by laboratory parameters. In cases of adverse events the drugs may be reduced or withdrawn based on clinical and laboratory results. The improvement over the last decade of laboratory assays has paralleled the success in the sustained response rates reported for hepatitis C virus treatment. A good laboratory provides the tools for diagnosis and treatment essential for good management. This is a multidisciplinary approach involving all branches of pathology.

Hepatitis C virus seroprevalence rate among Saudis.

OBJECTIVE: The aim of the study is to determine the seroprevalence of hepatitis C virus (HCV) in blood donors, children, pregnant women, hemodialysis patients and drug addicts in Saudi Arabia. METHODS: Using third generation enzyme immunoassay kits, we have screened Saudi cohorts of all ages and sexes, namely infants, pre-school, school children, young adults and adults (blood donors and antenatals) for antibodies to HCV. We have also reviewed HCV seroprevalence data among high risk groups from 1998 to 2002. RESULTS: An overall 1.1% (6313 out of 557813) seroprevalence rate was determined among Saudi blood donors; 0.1% (5 out of 3854) in Saudi children; and 0.7% (22 out of 3127) among pregnant women. Hemodialysis patients remain at highest risk of infection at 55.7% whereas intravenous drug addicts have 14% exposure rate. CONCLUSION: We conclude that the present public health schemes have been effective in reducing hepatitis C infection in the general community in the Kingdom of Saudi Arabia but the infection among high risk groups remain a major problem that needs to be actively addressed.

Hepatitis C genotypes/subtypes among chronic hepatitis patients in Saudi Arabia.

OBJECTIVE: The object of this study is to determine the molecular epidemiology of hepatitis C virus (HCV) in the Kingdom of Saudi Arabia (KSA). METHODS: Four hundred and ninety-two histological proven chronic HCV patients prospectively recruited from all regions of KSA, between November 1999 and March 2002, were genotyped and subtyped using amplified products of specific primers from the 5-UTR region in a reverse transcription polymerase chain reaction (Roche Diagnostics, Switzerland) followed by a reverse hybridization technique (Innolipa HCV II [Innogenetics, Belgium]). RESULTS: Sixty-two percent of Saudis were found to be genotype 4. Other genotypes were 1 (24.1%); 2 (7.4%); 3 (5.9%); 5 (0.3%); and 10 (0.3%). There were no differences in distribution patterns between sexes and ages. All regions showed similar distribution except the Eastern region where subtype 2a/c seem to have emerged. Diabetic patients and those with a history of blood transfusion had the same pattern as those with community acquired HCV. Among the non-Saudis (mostly Egyptians), genotype 4 predominated (88%). CONCLUSION: We conclude that 86% of Saudi chronic hepatitis C cases are due to genotypes 1 and 4. Since these are considered "difficult to treat" an aggressive approach to management using combination therapy of pegylated interferon plus ribavirin for 48 weeks should be considered for all cases of chronic hepatitis C until genotyping proves otherwise.