الفهرس 
Chapter 1: HCV InfectionOnly 14 pages are availabe for public view
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Abstract
Chronic hepatitis C (CHC) is a major health concern worldwide and although often clinically silent, it is histologically an insidiously progressive disease leading to liver fibrosis, cirrhosis and HCC. Egypt has the highest prevalence of adult HCV infection in the world (15–25%). The main (90%) HCV genotype is type 4. Studies of the magnitude of HCV infection in Egyptians revealed an overall prevalence of 8.7% in upper Egypt and 24.3% in lower Egypt and in those under 19 years of age it was 3%in upper Egypt and 9%in lower Egypt.It has been reported that in HCV infection the production of inappropriate levels of cytokines is associated with virus persistence and failure of antiviral therapy.HCV patients who are genotyped as high IL-10 producers have a poor response to interferon therapy, these patients may therefore benefit from additional treatment strategies designated to enhance Th1 responses.The aim of the study was to investigate serum levels of IL-10 and its impact on early virological response in Egyptian patients with chronic HCV treated with interferon plus ribavirin.The present study was conducted on 40 egyptian naϊve chronic HCV patients (22 males & 18 females, with mean age was 37.9 ±10.6 years). Studied patients were divided into 2 groups according to their early virological response )EVR(; group )І(: EVR group which is composed of 30 patients (75 %( and group )Π( : the non responders )non EVR) group which is composed of 10(25%) patients.All patients were subjected to the following:
1. Full history taking.
2. Clinical Examination.
3. Laboratory investigations including:
A. Complete blood count (CBC).
B. Liver function tests.
C. Viral markers including (HCV Ab and HBs Ag).
D. HCV- RNA PCR. This test will be done pretreatment then 12, 24 then 48 weeks after the start of treatment then 6 months after the end of treatment.
E. Anti-nuclear anti body (ANA).F. Thyroid function test (TSH).
G. Serum level of interlukin 10 (IL 10) before beginning of treatment &3 months after onset treatment. 4. Abdominal ultrasonography. 5. Liver biopsy will be done for histopathological grading and staging of hepatic fibrosis by experienced pathologist using the METAVIR scoring system. In the present study there was statistical significant difference between EVR group and non EVR group as regard baseline viral load which was more higher in group )Π( than group )І( )5.82x 105 IU/ml versus 477.66x105IU/ml) with statistical significant difference. In present study there was statistical significant difference between EVR group and non EVR group as regard baseline histopathological findings.In this work we demonstrated that pretreatment mean level of serum IL 10 was lower in EVR group than that in non EVR group with highly statistically significant difference.In this work we found that interlukin 10 at cut off <5.4 (pg/ml) has high sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPP) (95.7%, 98.5%, 95.4%, 95.7%, 98.5%) respectively in achieving EVR, so it is a good prognostic marker for evaluation of response to interferon and ribavirin therapy.