الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Approximately 350 million people are infected with HBV worldwide, and the World Health Organization (WHO) estimates that approximately 170 million people are infected with HCV. HBV and HCV infection account for a substantial proportion of liver diseases worldwide. Because the two hepatotropic viruses share same modes of transmission, coinfection with the two viruses is not uncommon, especially in areas with a high prevalence of HBV infection and among people at high risk for parenteral infection. The exact number of patients infected with both HCV and HBV is unknown.
Occult HBV infection has frequently been identified in patients with HCV-related chronic hepatitis.
Considerable data suggested that occult infection may contribute to chronic liver damage and the development of HCC.
Despite its potential clinical importance, the prevalence of occult HBV infection in patients with hepatitis C is still undetermined or well known . Accordingly a low-level HBV infection not only may contribute to the severity of HCV-related liver disease but also may be of prognostic importance.
HBV was the second commonest cause of acute liver failure in the Egypt.
The aim of this study is to determine the prevalence of occult HBV among HCV infected patients. One hundred anti HCV positive patients and HBs-Ag negative attending the Microbiology department in Medical research institute (MRI) Alexandria university during the period between 2011- 2012 were included in this work .
Blood samples were collected from all Patients left to clot. Serum was separated by centrifugation at 1500 rpm then stored in small aliquot at -20°C for further investigation. Sera were tested for the following investigations:
1-Detection of anti-HCV by ELISA: (Abbott Murex Diagnostic Division).
2- Detection of HCV RNA using (Artus HCV QS-RGQ PCR Kit)
3- Detection of the following serological markers for HBV by ELISA (CTK Biotech, Inc) ®
a- Detection of HBsAg by ELISA (Abott Murex Diagnostic Division)
b- Detection of anti-HBc by ELISA (CTK Biotech, Inc)
4- Detection of HBV-DNA by Nested PCR using specific primers for pol genes.
5- Detection of s and c and x genes of HBV DNA by Syber green Real Time PCR (AB: Applied Biosystem) using specific primers.
6- Determination of liver enzymes by full automated (Biosystem) including:®
a- Aspartate aminotransferase(AST ).
b- Alanine aminotransferase (ALT ).
c- Total and direct Serum bilirubin.
d- Serum albumin.
Out of the 100 anti-HCV positive/ HBsAg negative patients (79%) had an age between 20-40 years and (64%) of them were males. The majority (83%) of CHC patients had a viral load of (105-106 IU/ml) and had abnormal AST and ALT levels (62% and 40%) respectively.
The 100 anti-HCV positive and HBsAg negative patients were then tested the presence of anti HBc and 58% of them were anti-HBc positive. HBV DNA by Nested PCR for pol gene was detected in 18% . These 18 pol gene positive samples were then tested for genes (s, c and x) and the core gene was detected in 10 (56%) while x gene could be detected in 6 (33%) and s gene detected in 3 (17%) out of 18 pol positive patients. Several gene profiles were detected, the main profiles detected were the presence of the 2 genes cx (22.3%) and c (27.8%) of patients, s in (11.1%) and (scx or x) in 5.5%,(sx,cs )no detected. As regards to liver enzymes among occult HBV (pol gene positive) patients significantly difference was noticed among anti-HBc positive and anti-HBc negative as (77%) and (55%) of both groups had elevated AST and ALT respectively.
High HCV RNA load can be noticed between patients with occult HBV/HCV (94.5%) those with mono HCV infection (80%). Also liver enzymes were higher among occult HBV (AST 77%, ALT 55%) compared to HCV monoinfection patients (AST 57%, ALT 38%).