الفهرس 
HCV infectionOnly 14 pages are availabe for public view
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Abstract
Hepatitis C is a disease with a significant global impact. According to the World Health Organization there are 130-170 million people infected with hepatitis C virus (HCV). There are considerable regional differences. In some countries, e.g., Egypt, the prevalence is as high as 22% (WHO, 2011).
Viral kinetic response at 24 to 48 hours after the first dose of peginterferon and ribavirin may predict the ultimate antiviral efficacy in patients with hepatitis virus C, according to results of a multi-center study (Durante-Mangoni et al., 2009).
Data indicate that peginterferon alpha-2b plus ribavirin treatment produces significant changes in HCV dynamics that can be detected as early as 48 h after the first dose of peginterferon alpha-2b and that these changes are useful in predicting response to therapy in CHC patients (Gallegos-Orozco et al., 2005).
A decay of HCV-RNA ≤0.8 log at 48 hrs indicated a 95% negative predictive value (NPV) for SVR in chronic hepatitis c virus monoinfected patients (Durante-Mangoni et al., 2009).
To fullfil the aim of the work, this study was designed to assess the very early changes in HCV viral load after the first dose of pegylated interferon plus ribavirin by quantitative P.C.R. And to assess the predictive value of very EVR in HCV infected patients in Egyptian patients with chronic HCV viral infection.
This study was conducted in co-operation between Tropical Medicine Department, Ain Shams University and Kafr EL-Sheikh Liver Research Center, in the period from April 2010 to April 2012. The patients enrolled in our study were selected from Kafr EL-Sheikh Liver Research Center. We operated our study on selected 40 patients of chronic liver disease with proven chronic hepatitis C virus infection by history taking, clinical manifestations and positive laboratory investigations for chronic HCV infection to fulfill the predesigned inclusion criteria.
All patients were subjected to the following; careful history, thorough clinical examination and laboratory investigations [liver enzymes (AST and ALT), serum albumin, INR, total and direct bilirubin, complete blood picture, viral markers (HCV-Ab, HBs-Ag and quantitative PCR for HCV-RNA), lipid profile (fasting serum cholesterol and serum triglycerides) and glucose profile (fasting blood sugar and 2-hours post-prandial blood glucose). Abdominal ultrasound and histopathological examination of ultrasound guided liver biopsy were done for all cases.
The clinical presentations of the studied group; abdominal pain was present in 18 patients (45%), while easy fatigability was present in 35 patients (87.5%), and hepatomegaly was present in 9 patients(22.55%).
The current study reveals that the median log HCV RNA (IU/mL) significantly decreased 2 days after starting the combined therapy of chronic HCV infection [before treatment (5.2±0.8) and after treatment (3.1±1.8)] (P<0.001). Correlation of viral kinetics with treatment outcome can give an indication of ultimate outcome, allowing modification or withdrawal of treatment at an early stage.
Concerning the baseline Log HCV RNA levels, the study reveals that however the Log HCV RNA levels before treatment were slightly higher in positive than negative HCV RNA cases (2 days after treatment), but without significant difference.
The present work designed a logistic regression model beginning with various studied variables before treatment to find out prognostic factors of HCV RNA negative conversion 2 days after treatment, low Log HCV RNA was found to be a good significant prognostic factor for HCV RNA negative conversion.
No statistical relation could be elicited between those being –ve or even decrease in log after 2 days and those being –ve at week 12, 24, 48 and 72 weeks. This is explained by that most of the cases show decrease in the log of PCR after 2 days as well as the few number of the selected cases.
The current study conclouded that the evaluation of HCV-RNA decline at 48 h appeared easy to be performed and able to yield a remarkable amount of information for SVR.