الفهرس 
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Abstract
HCV infection is a major public health burden in Egypt, where it bears the highest prevalence rate in the world. chronic infection with HCV is the leading cause of end-stage liver disease, HCC and liver-related death.
In Egypt, HCV is not only a complicated disease process but a serious public health, economic, and social problem that transcends the boundaries of biomedicine. Genotype 4 is the most common variant of HCV throughout Egypt and represents more than 90% of HCV isolates from Egyptian patients.
Until 2015, the SOC for treatment of CHCV in Egypt was weekly injections of peg-IFN/RBV for 48 weeks. Unfortunately, the medications are poorly tolerated and result in low response rates, with only half of patients achieving HCV clearance. Prediction of treatment response is necessary for decision-making in the management of CHCV. This could save a great deal of suffering and expense.
Several host and viral factors were studied as predictors of the combined peg- IFN/RBV therapy. IL28B polymorphism was reported asanindependent predictors of SVR with its most favorable CC genotype.
HCMV is a common pathogen of severe disease in patients with impaired immune functions. Reactivation of HCMV in immunocompetent host is usually asymptomatic, but may deteriorate the prognosis of patient with chronic illness. The relationship of HCV infection with HCMV was reported in few studies.
The aim of this study was to assess the role of IL28B polymorphism combined with HCMV and HIV infection as predictors of treatment response in chronic HCV patients.
This study was conducted in the period from December 2013 through June 2016 at CRC located in the New Specialized University Hospital, Alexandria University and at the MRI–Alexandria University.It included 75 patients (43males and 32 females) with CHCV (known to have HCV more than 6 months) who would start combined peg-IFN/ RBV therapy for 48 weeks.Patients’ age ranged from 21 to 60 years old. HCV RNA was assessed before treatment. Follow up at 3,6,12 and 18 months was done by assessing HCV RNA. All patients were tested for HIV I and II antibodies, HCMV IgM and IgG, HCMV DNA and IL28 B polymorphism.
The main results of the study included:
1. There was statistical significant difference between responders and non-responders as regards HCMV DNA (p=0.012).
2.Relapse was associated with those have HCMV DNA (100%).
3. Most of CHCV patients carry CT genotype (64%), which is associated with the high non response of IFN therapy or relapse after 48 weeks of treatment and this was statistically significant (p(MC)=0.010).
4.There was statistically significant difference in age between responders and non-responders (p(MC)=0.000).
5. There was no statistical significant difference between responders and non-responders regarding sex (p=0.087), baseline viral load (p=0.024), hemoglobin (p=0.588), WBCs (p=0.166) and platelets (p=0.024).
6.There was statistical significant difference between responders and non-responders regarding ALT(p=0.001) and AST (p=0.000) at 3 months of therapy.
7. There was statistical significant difference between responders and non-responders regarding the grade of liver fibrosis (p(MC)=0.000).
In conclusion:
1. Age >49 was statistically significant discriminator of occurrence of response.
2.HCMV DNA in CHCV patients was a predictor of response to treatment to peg-IFN/RBV therapy in this study.
3.Relapse was associated with those carrying T allele of CT or TT genotypes of IL28B and with positive HCMV DNA.
4.Sex, viral load, haemoglobin, WBCs and platelets have no significant difference between responders and non-responders and were not predictors in this study.
5.Liver fibrosis was a negative predictor in this study.