الفهرس 
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Abstract
Summary
Hepatitis C virus (HCV) infection is a global health problem, being the second most common chronic viral infection in the world, with a global prevalence of about 3% (about 180 million people). Egypt has the highest prevalence of HCV worldwide (15%) and the highest prevalence of HCV-4. At least 100,000 deaths are annually attributable to hepatitis C, HCV is transmitted by several ways including contaminated blood and blood products, needle sharing, contaminated instruments (e.g. in hemodialysis, reuse of contaminated medical devices, tattooing devices, acupuncture needles, razors, and manicure devices), and occupational and nosocomial exposures. The currently recommended therapy of chronic HCV infection is the combination of a pegylated interferon alpha and ribavirin for a period of 24-72 weeks. The cytokines prompting development of the T helper type 1 (Th1) immune response are of particular interest for potential immunotherapy against HCV . One of these cytokines is IL-18 that described as a member of the IL-1 cytokine superfamily and was initially characterized as IFN-γ inducing factor. It has the capacity to activate both Th1 and Th2 responses. Many reports, suggest that IL-18 play a role in viral infections. The increase in the expression of IL-18, has been shown to correlate HCV persistence. The current work aimed to estimate serum IL-18 concentration in HCV patients in this area and to correlate it to response to combined therapy (peg-INF-α plus ribavirin). A total of 45 patients (26 males and 19 females, aged 21-60 years) with CHC attending Endoscopy Unit of SCU hospital from November 2011 to January 2012 to perform percutaneous liver biopsy for fibrosis scoring as a line of their management, included in this study. The patients were divided into two groups based on early virologic response (EVR)
to combined PEG-IFN α-2a (Reiferon Retard®/Ribavirin) therapy after 12 weeks of starting treatment. 45 healthy blood donors (30 males and 15 females, aged 19-60 years) with normal liver function tests (LFTs) and negative results for both anti-HCV antibodies and HBV surface antigen (HBsAg) were included as control group. Quantitative detection of serum IL-18 was performed before continuous IFN therapy using commercial ELISA kit.There were a significant difference between HCV patients and control(p<0.001). Patients were classified based on their response to IFN after 12 weeks of therapy into 36 (80%) responders and 9 (20%) non-responders. Pretreatment serum levels of IL-18 tend to be lower in responders than non-responders. ROC curve established a serum IL-18 cut off value of ≤ 482.5 pg/ml (sensitivity and specificity of 58.3% and 66.7%, respectively) which show that IL-18 could be a predictor of response to combined PEG-IFN α-2a therapy.