الفهرس 
Hepatitis C VirusOnly 14 pages are availabe for public view
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Abstract
T
he World Health Organization has declared hepatitis C global health problem with approximately 3% of world population (roughly 170-200 million people) infected with HCV. In Egypt the situation is quite worse as it has the highest prevalence of HCV in the world, 12-13%, and interestingly genotype 4 HCV represents over 90% of cases.
Pegylated interferon (PEG-IFN) Alfa in combination with ribavirin (RBV) is the standard of care for adults with chronic hepatitis C. The main advantage of PEG-IFN Alfa is the extended serum half-life conferred by Pegylation of the IFN molecule, which permits a once-weekly administration regimen with improved efficacy and safety profile similar to that of IFN Alfa.
This study was designed to assess the correlation between the sustained virological response (SVR) and degree of hepatic fibrosis detected in histological examination of liver biopsy specimens. It was conducted in co-operation between Tropical Medicine Department, Faculty of Medicine, Ain-Shams University and Tropical Medicine Department, out patients’ clinic of National Hepatology and Tropical Medicine Research Institute (NHTMRI) in the period from April 2009 to October 2010.
The current study included 58 patients who fulfilled the pre-designed inclusion criteria which were (Adult patients ≥ 18 years and less than 60 years old with clinical, biochemical and ultrasonographic criteria of chronic liver disease (Child A), non-obese (BMI ≤30), positive serology for HCV antibody and HCV vireamia by PCR, and with advanced fibrosis).
All the studied cases were subjected to the following; full history taking, thorough clinical examination, laboratory investigations [complete blood count (CBC), liver function tests including: serum AST, ALT, bilirubin, albumin, prothrombin time (PT) and INR. Hepatitis Viral markers; HBsAg and HCV-Ab. Quantitative HCV-RNA by PCR, as well as glucose profile, TSH, AFP, ANA, abdominal ultrasound and liver biopsy with histopathological examination of the biopsy specimens.
Eligible patients received therapy with either PegIFN-α-2a 180 μg/week subcutaneously, or PegIFN-α-2b 1.5 μg/kg once/week subcutaneously plus ribavirin 1000-1200 mg/day (for body weight <75 kg or ≥75 kg, respectively). Patients were treated for 48 weeks, and then followed by additional 24 weeks period to assess SVR. Patients enrolled in the study, were prospectively evaluated as outpatients every month of therapy and at 12 and 24 weeks post- treatment.
The studied patients were 58 patients [41 males (70.7%) and 17 females (29.3%)] with a range of age from 18 to 60 years. The histopathology examination of the liver biopsy specimens revealed 35 patients (60.3%) with stage 5/6 of fibrosis and 23 patients (39.7%) with stage 6/6.
A virological response when undetectable HCV RNA in serum by qualitative PCR was achieved at the end of treatment and SVR was considered when undetectable HCV RNA in serum by qualitative PCR was achieved at the end of 6 months follow-up after the end of antiviral therapy.
The results of our study shows that 10 patients (28.6%) with fibrosis stage 5/6 showed SVR at week 72, in comparison 2 patients (8.7%) only with stage 6/6 shows SVR at week 72. The results confirm that SVR rates occur at week 72 instead of 48 weeks in patients with advanced cirrhosis moreover, no significant statistical difference between these two advanced stages of fibrosis.
The overall SVR in patients with advanced fibrosis is low with both high failure rates and relapse rates; the overall treatment outcome with negative PCR 6 months post treatment was achieved in 20.7% (12/58 patients) and failure rate of %79.3 (46/58patients) and relapse rate inn27.6% (16/58 patients).