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The
Natural History of Untreated Symptomatic
Acute Hepatitis C Infection in Egypt
Zakaria Sohir,Fouad Rabab,Shaker Olfat*
, El Akel Wafaa,
Hashem Ahmed,ElAide S**, Zakaria Serag
and Lee S***.
Tropical Medicine and Medical
Biochemistry Department* , Kaser El Aini
Hospital Cairo University and Embaba
Fever Hospital**
University of Calgary, Alberta,
Canada***
Abstract:
Background& aim: The medium-term natural
history of acute hepatitis C infection
remains unclear in untreated patients.
We therefore aimed to clarify the
natural history of acute symptomatic
hepatitis C in an untreated Egyptian
cohort. Methods: The diagnosis of acute
symptomatic hepatitis C in 30 patients
was based on clinical and biochemical
criteria, and the presence of HCV RNA in
the first serum sample.
Results: Acute HCV more frequently affected younger
persons (20-29 years), and the main risk
factor was parenteral injection (43%).
Combined infection with other viruses
was frequent, especially with HBV. Anti-HCV
seroconversion occurred in 83%. In 21
patients (70%), HCV RNA showed a
relapsing pattern, with at least one
period of undetectability, followed by
positivity. HCV RNA was undetectable in
67% at 6 months of follow up; however
this percentage decreased progressively
with extended followup, dropping to 50%
at 12 months, 14% at 24 months and 13%
at 36 months. ALT levels significantly
declined after the first month, but
continued to fluctuate at approximately
twice the upper limit of normal in
23-33% of patients at each follow up
time to 36 months.
Conclusions: Our
patients with acute HCV frequently had
transient periods of HCV RNA negativity
during the first 24 months after
infection, but 87% were viremic at 36
months. The pattern of serial HCV RNA
and ALT measurements within the first
few months could not discriminate
patients who cleared virus from those
who did not indicating the need for
extended followup in these patients.
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