Management of HCV chronic infection in
hemodialysis patients
HCV infection is the leading cause of
chronic liver disease and Hepatocellular
carcinoma in the world. Dialysis
patients are at higher risk of acquiring
HCV infection. The available data
suggests that HCV infection is a poor
prognostic factor for survival among
patients with end stage renal failure.
The recommended therapy of most patients
with chronic HCV infection who do not
have renal dysfunction consists of
interferon alfa (preferably pegylated
interferon) in combination with
ribavirin. Monotherapy with interferon
alfa is the recommended line of therapy
for HCV infection in dialysis patients
currently.
We will present our unit experience
(pilot study) in treating HCV infected
patients with combination therapy of
interferon alfa plus modified dose of
ribavirin. Also we will present our
latest data of the combination of
pegylated interferon and ribavirin in
the treatment of our haemodialysis
patients.
The main screening assay for detecting
anti-HCV antibodies is the enzyme
immunoassay (EIA). Three so called
“generations” of EIAs have been
developed which each new generation
providing incremental improvements in
the sensitivity to antibodies against
the Hepatitis C virus. The
first-generation anti-HCV test (EIA-1),
introduced in 1989, contained a single
HCV recombinant antigen derived from the
nonstructural (NS) 4 gene, designated
c100-3. Although development of this
test represented a dramatic breakthrough
in terms of diagnosing HCV infection and
reducing HCV transmission via blood
transfusion, EIA-1 lacked optimal
sensitivity and specificity and was
subsequently replaced in 1992. The EIA-2
tests contained additionally HCV
antigens from the core and NS3 genes and
use of these new antigens led to a
substantial improvement in sensitivity
and a slight increase in specificity
relative to the EIA-1. The use of core
and NS3 antigens in the EIA-2 tests
shortened the average "window period"
for HCV seroconversion by 4-10 weeks
relative to the EIA-1 tests. The
third-generation anti-HCV test, which
were first presented in 1994, contains
NS4 and reconfigured core and NS3
antigens plus an additional HCV antigen
(NS5) not present in the EIA-2. Several
studies have shown an incremental
improvement in sensitivity in blood
donors, immuno-suppressed populations,
and liver clinic populations. The
average period for HCV seroconversion
after infection has been shortened by an
additional 2-3 weeks compared to EIA 2.
It could be shown that the enhanced
sensitivity was achieved by the
modification of the c33 protein (NS3)
and not the inclusion of NS5.
Currently, new assays are being
developed combining the detection of HCV
antigen as well as antibodies. In HIV
detection, these types of assay have
clearly improved accurate diagnoses at
the time patients are presenting with
symptoms. The concept seems even more
convincing for HCV with its long
seronegative window of 70 days after
infection which is also the reason why
many countries have included HCV NAT
testing for a safer blood supply.
Interestingly, not as many additional
HCV infected donors have been found as
predicted – probably because the
incidence of new HCV infections in blood
donors is rare. The question could be
raised whether a sensitive Combo assay
may serve the same purpose, especially
in countries where HCV NAT has not yet
been established. The assay should help
to make a safer diagnosis in areas with
higher incidence such as testing in
dialysis patients or when dealing with
high risk populations.
The development of very sensitive HCV
antigen assays may offer some options to
monitor treatment in HCV patients. While
quantitative PCR is necessary to define
values before and at end of treatment,
it may be of great help for the patient
to see decreasing values in HCV antigen
helping to stay compliant in a therapy
with sometimes staggering side effects.
Prolonged Therapy Of Chronic HCV With
Combined Low Dose Oral Interferon Plus
Ribavirin
Prof. Mohie M Amer
Some reports have been described effects
of low-dose human interferon-a (Hu IFN-a)
given orally on immune-based diseases
such as polymyositis, multiple
seleroisis, and Sjogeron's syndrome.
Furthermore, Hu IFN-a have been given
orally in low doses to treat or prevent
a number of infections in a variety of
species e.g. respiratory tract
infections in cattle, inflammatory
airway diseases in horses, transmissible
gastro-enteritis or rotavirus diarrhea
in swine, and chronic active hepatitis B
in humans. We have evaluated the
possibility of using low-dose oral HU
IFN-a plus ribavirun for extended
periods (24 months) in patients with
chronic hepatitis C. Forty Egyptian
patients with chronic hepatitis C were
given sublingual 400 IU of IFN-a plus
800-1200 mg of oral ribavirun daily.
Serum transaminases and HCV-RNA levels
were monitored before, during and after
therapy. Liver biopsies were carried out
before and at the end of treatment. With
therapy, the mean ALT level showed
initial increase in the first 3 months
(from 126 U/L to 183 U/L) then fell
gradually to reach the normal level at 6
months and continues to be within the
normal range fro the rest of the study
period. Serial geometric mean of HCV-RNA
levels showed steady decrease along the
study period starting at 6 months. Only
one patient (2.5 %) tested negative by
the bDNA assay at 6 months while another
3 patients tested negative at 12 months
(4/40, 10%). At 18 months, 9/40 patients
were negative (22.5%), while at 24
months the total number of patients who
tested negative for HCA-RNA in serum
were 15/40 patients (37.5%). Liver
histology obtained at 24 months of
therapy showed highly significant
improvement in the total histology
activity index (HAI) scores in all
patients. It could be concluded that
therapy with low dose oral IFN plus
ribavirin improved biochemical,
virological and histological markers in
Egyptian patients with chronic hepatitis
C
IMPACT OF HEPATITIS G VIRUS INFECTION ON CHRONIC HEPATITIS C
PATIENTS: CLINICAL, VIROLOGICAL AND
ULTRA STRUCTURAL ASPECTS
M.H. Hassanein, M.M. Omar, N.A. Fam,
S.S. El-Din2, H.M. Yehia, M.M Siam, M.M.
Saber, H.A. Hanem Ahmed , M.A. Rorneih.
Hepatology, Microbiology,
Electronmicroscopy, Pathology,
Biochemistry,
Theodor Bilharz Research
Institute,
Giza, Egypt
Introduction : Hepatitis G virus (HGV)
co infection in chronic hepatitis C
patients has recently been an active
area of research as the impact of HGV
infection on HCV chronic liver disease
is still controversial.
Aims and Methods : This study was
conducted to investigate the prevalence
of HGV infection in ultra structural
level on chronic HCV liver disease.
One hundred chronic HCV patients and 80
healthy blood donors were subjected to
clinicolaboratory and ultrasonographic
examination. Blood samples were examined
for HCV and HBV markers, HCV
stereotyping, HCV quantitation of viral
load and HGV RNA detection by nested
Rt-PCR, Liver biopsy specimens were
obtained from 35 patients and processed
for light and electron microscopic (EM)
examination.
Results : Chronic HCV patients were
classified into 4 groups : chronic
hepatitis (CH = 45) compensated
cirrhosis (CC =-11); decompensated
cirrhosis (DC=22); and hepatocellular
carcinoma (HCC-22). The prevalence of
HGV infection was significantly higher
in chronic HCV patients (19%) versus
blood donors (5%) P<0.001. HGV viremia
was significantly more common in
patients with mild liver disease (CH+CC)
than in patients with severe liver
disease (DC+HCC) (23.2% versus 13.6% )
P<0.05.
No Significant difference wad detected
between HGV-infected and non-infected
patients regarding mean age. sex. liver
biochemical tests, virologic markers and
HCV serotype distribution. Decompensated
cirrhosis was significantly less common
in HGV co infected persons (5.2%), than
in those with isolated HCV infection
(26%) P<0.01.
Also the HCV RDNA viral load in the
former group was lower (median 2.1 x 105
+/- 0.4) than in the latter group
(median 2.9>-105_o.5) but the difference
was statistically insignificant
(P>0.05). Histopathology examination of
liver biopsy specimens by light and EM
revealed no significant difference in
the grade of periportal, portal and
intralobular necroinflammation and in
the stage of fibrosis. No virus
particles or any characteristic
morphological discrimination were
detected between HJCV patients with and
without HGV infection.
Conclusion : HGV infection is common in
chronic HCV patients. It does not appear
to aggravate the liver disease at the
histopathology and the ultrastructural
levels, but the finding that it was less
prevalent in clinically severe liver
disease than in those with mild disease,
plus the lower HCV RNA levels in co
infected patients raise the speculation
of a possible beneficial role. Much more
in-vitro and in vivo studies are
required to answer the question related
to interaction of both viruses.
Hepatocyte Apoptosis in Chronic
Hepatitis C:
A prominent Feature of Disease Severity
in Egyptian Patients
Zakaria S1, Akl M2., Hammam O2., El
Raziky M.1, , Fakhry S.3, Seyam M.3,
Ibrahim R.3 ,Yehia H.4 , El Hindawi A.5,
El Behairy N.3
Departments of: 1 Tropical Medicine, 5
Pathology, Faculty of Medicine, Cairo
University. Departments of 2 Pathology,
3 Tropical Medicine, and 4 Electron
Microscopy, Theodor Bilharz Research
Institute.
Background and Aims: Chronic hepatitis C
virus (HCV) is a major health problem in
Egypt, where genotype 4 is the most
prevalent. There is increasing evidence,
from recent studies, suggesting that
liver damage in chronic HCV genotype 1
and 3 is mediated by the induction of
apoptosis. The aims of this study were
to assess hepatocyte apoptosis in
chronic HCV patients, correlate it with
disease severity, and to identify
possible mechanisms of apoptosis
induction. Methods: The study included
57 selected patients diagnosed on
clinico-pathological and virological
bases as chronic HCV , in addition to
five control cases. Liver specimens were
studied according to the grade of
inflammation, and steatosis, and stage
of fibrosis. Immuno-histochemical (IHC)
studies using both the monoclonal anti-Fas
and anti-p53 mutant gene were performed.
Electron microscopic study for 8 cases
were done.
Results: Apoptosis was
focally demonstrated in liver sections
by detecting Fas antigen expression in
84.2% of patients compared to no
expression in controls. A positive
correlation was observed between Fas
expression and grade of inflammation,
stage of fibrosis, serum ALT, AST, ALP,
and viral load. P53 was over expressed
in 29.8% of patients, showing
significant direct correlation relative
to the grade of activity, stages of
fibrosis, serum albumin and bilirubin
levels, ALP and viral load. Significant
direct correlation were detected between
hepatic steatosis and both Fas and p53
positivity. Magnifying ultrastructural
apoptotic changes were seen in all the
eight specimens, six of them revealed
Fas positivity and none of them showed
p53 positivity.
Conclusions: Hepatocyte apoptosis
through Fas antigen expression is
significantly increased in Egyptian
patients with chronic HCV and correlates
with disease severity. We suggest the
term “apoptotic activity” instead of
“necroinflammatory activity” in
describing chronic HCV interface areas.
Mutant P53 is over expressed in the
precocious stages of HCV related liver
damage before carcinogenesis indicating
close follow-up.
A COMPARATIVE STUDY BETWEEN PEGYLATED
VERSUS CONVENTIONAL INTERFERON FOR THE
TREATMENT OF CHRONIC HEPATITIS C
INFECTION IN ADULT TRANSFUSION DEPENDENT
THALASSEMIC PATIENTS: AN OPEN LABEL,
RANDOMIZED TRIAL
S. Mirmomen1, N. E. Daryani1, B.
Haghpanah1, P. Poorsamimi2, S. Alavian3,
R. Malekzadeh4, M. R. Zalli5
1Gastroenterology and Hepatology, Imam
Khomeini Hospital, 2Infectious disease,
Private, 3Gastroenterology and
Hepatology, Tehran Hepatitis Center,
4Gastroenterology and Hepatology,
Digestive disease reaserch center,
5Gastroenterology and Hepatology,
Taleghani hospital, Tehran, Iran
(Islamic Republic of)
INTRODUCTION: Interferon monotherapy is
currently the only approved treatment
for chronic hepatitis C (CHC) infection
in transfusion dependent (TD)thalassemic
patients, in which ribavirin has limited
use because of its hematologic
complications.
AIMS & METHODS: Our aim was to compare
the efficacy and safety of conventional
Interferon Alfa (CINF) with that of
Pegylated interferon Alfa (PINF) for
these patients.This trial was a
multicenter, open label, randomized
prospective study. 50 TD-thalassemic
patients, with CHC infection were
randomized to receive either CINF 3 MU,
three times per week (n=25) or PINF (PEGASYS)
180 Mic-g, once weekly (n=25) for a
period of 48 weeks. Efficacy was
assessed by measuring serum HCV-RNA
following a 24 week treatment-free
period (SVR)
RESULTS: there was no significant
difference between the pretreatment
liver histology (including fibrosis and
siderosis) between the groups. HCV
genotype 1 was dominant in both groups
(> 75%). Three cases of neutropenia
occurred in PINF group, which warranted
dose reduction, but in CINF group one
such a case happened. In PINF group two
patients had an elevated end of
treatment serum ALT instead of negative
HCVRNA but their ALT returned to normal
as soon as the treatment stopped, these
2 patients were considered to have INF
toxicity. Two patients in PINF and one
in CINF group missed follow up
(unrelated to drug adverse reactions).
Perprotocol analysis showed that; SVR
was 60.9% (14 out of 23 ) in PINF group
and 29.2% (7 out of 24) in CINF group
(P=0.029)
CONCLUSION: Our study showed that in TD-thalassemic
patients, in which ribavirin is not
approved; monotherapy with PIFN is
superior to CINF.
Cytokines in per portal fibrosis in
human infected with schistosoma mansoni,
viral hepatitis and its role in
pathogenesis
ABDEL ATTY ELGONIMY, SUZAN FAROK,
EMAN.M.ABDEL RAHMAN Surgical &Clinical Pathology
Department,
Banha Teaching Hospital& Internal
Medicine,
Faculty of Girls,
Al Azhar University
ABSTRACT
Background: Cytokines, low molecular
weight proteins with a road range of
activity, as well as in the pathogenesis
leading to liver damage.
Cytokines play a key role in the
regulation of immune responses. In
hepatitis virus infection the production
of inappropriate cytokine level appears
to contribute to viral persistence and
to affect response to therapy.
Patients and Methods: To evaluate the
pathognomic role of endogenous IL-1B,
IL-6 and IL-10 in chronic liver disease
and to determine its relation with liver
fibrosis, forty patients with chronic
liver disease were classified into four
main groups:
Group I: 10 patients with bilharzial
liver disease, Group II: 10 patients
with chronic hepatitis C, Group III: 10
patients with chronic hepatitis B, group
IV: 10 patients with chronic hepatitis B
and C and 10 normal adult age and sex
matched as control groups
Results: We found that All
patients with chronic liver disease
(n=40) have highly significant elevation
of serum IL-1B, serum IL-6 and serum
IL-10 (P<0.01) when compared to control
group. Also showed after classification
the patients into 4 groups each group
highly significant elevation of serum
IL-1B, serum IL-6 and serum IL-10
(P<0.01) in each group when compared to
control group. But no significant
difference was found when the levels of
cytokines were compared to etiology of
chronic liver disease.
A significant correlation between the
level of serum IL-1B, IL-6, and serum
IL-10 and degree of fibrosis was found,
the increased in serum level of IL-1B,
IL-6 was associated with increase the
degree of fibrosis but the mild and
moderate fibrosis were associated with
higher level of IL-10 while patients
with marked degree of fibrosis were
associated with lower level of IL-10.
Conclusion: The increase in serum level
of IL-1B, IL-6 and IL-10 in patients
with chronic liver disease and that
increase not depend on the etiology of
underlying liver disease, but that
increase of this cytokines were
associated with the degree of fibrosis
give a highlight about the complexity of
host immune.
DR.
MOHD RHA AL MARRI
INCIDENCE OF HEAPTITS B VIRUS IN THE
STATE OF QATAR: an epidemiology
overview.
Abstract: INCIDENCE OF HEAPTITS B
VIRUS IN THE STATE OF QATAR: an
epidemiology overview.
Background: The incidence of
hepatitis B virus (HBV) infection in the
Qatar is not reported . Since the
infection can have serious sequelae,
there is a continuing need to examine
its epidemiology so as to inform control
measures.
Objectives: We aimed to describe
the current HBV incidence and patterns
of transmission in the Qatar, to
estimate the rate of new carrier
infections, and to discuss implications
for the control of HBV through
immunisation. STUDY DESIGN: We analysed
routine Department of public health
surveillance data of acute HBV infection
(1995-2003) and data on Expatriates
HBsAg prevalence.
Results: The estimated annual
incidence of HBV infection in Qatar
increased from 2 per 100,000 population
to 94 per 100,000. popukation in 2003,
of which 16 per 100,000 Qatari
population and 1 per 100,000 population.
Male are predominate with 2: 1 ration
Conclusion: Despite the
availability of hepatitis B vaccine
national programs at birth, new
infections with HBV remain not uncommon.
The increase in the incidence over the
years are reflection of better
reporting, however the low incidence in
expatriates is noted after application
of expatriate on arrival screening
program and annual screening of those
working in high risk professionals. Data
after the pan nationals immunization in
Qatar needed to be addressed.
Role Of CT in Predicting Spontaneous
Rupture Of Hepatocellular Carcinoma: A
Life threatening condition
Abstract: Spontanous rupture of
hepatocellular carcinoma (H.C.C) is a
life-threatenig condition.The mechanism
is not clear but it is suggested that
rupture is perceded by rapid expansion
of the tumour secondary to bleeding
within its substance.To assess the value
of CT in predicting spontanous ruputre
of hepatocellular carcinoma, we reviewed
CT scans obtained 2 months before the
rupture of H.C.C in 20 patients (rupture
group) and within two months before
death of any case from other than
rupture of hepato-cellular carcinoma in
20 patients ( non-rupture group). All
the carcinomas in the rupture group were
located either at (14 cases) or near (6
cases) the surface of the liver.For the
ruputured group, the mean numbers of
involved liver segments were 4.2 +/- 2.3
compared to 2.3 +/- 1.3 ( P<.01). The
tumore size and propensity to rupture
failed to show correlation. For rupture
and non-rupture group respectively,
frequncies of tumour protrusion beyond
the liver edge was 89% and 50%;frequency
of presence of cirrhosis in
non-neoplastic hepatic tissue were 70 %
and 45 %.No significant difference in
age and sex of the patients and clinical
stage of the tumour were evdent between
the two groups. We conclude that the
extent of extrahepatic protrusion with
the prescence of cirrhosis in
non-neoplastic hepatic tissue are
associated with an increased risk of
spontanous rupture of hepatocellular
carcinoma."
DR.
EMAN ABDEL REHAMAN
VASCULAR ENDOTHELIAL GROWTH FACTOR AND
SOLUBLE ADHESION MOLECULES AS A
DIAGNOSTIC MARKER FOR SPONTANEOUS
BACTERIAL PERITONITIS IN CIRRHOTIC LIVER
DISEASE
HAMDIA
EZZAT AHMED, EMAN.M.ABDEL RAHMAN,
MAHA.M.ABDELMOHSEN Clinical Pathology & Internal
Medicine Department,
Faculty of Girls,
Al Azhar University
ABSTRACT
Background: Spontaneous bacterial
peritonitis (SBP) is a sever and
relatively complication of patients with
cirrhosis ascites that usually results
in renal failure and death despite the
efficacy of the current antibiotic
therapy.
Patients and Methods: The aim of
this study was determine serum and
ascitic fluid (AF) of vascular
endothelial growth factor (VEGF) soluble
L-selectine (sL-selectine),
intracellular adhesion molecule-1
(ICAM-1), and vascular cell adhesion
molecules-1 (VCAM-1) in cirrhotic
patients, and to search for a
relationship between them and SBP.
This study was performed on 30 cirrhotic
patients with SBP their age ranged from
(38-55) year with mean of (32±5.5), 30
cirrhotic patients with non infected
ascites their age range from (30-52)
year with mean from (35±6.5) this group
considered as cirrhotic control group
and 20 healthy control subject their age
ranged from (28-55) year with mean of
(30±7.5).
Results: We found that serum and
ascitic fluid of vascular growth factor
as well as adhesions molecules levels
were significantly higher in cirrhotic
patients with SBP as well as cirrhotic
patients with non infected ascites as
compared to healthy control group.
There was significant increase in serum
and ascitic fluid level of leukocyte,
PMN, and ICAM-1 in SBP as compared to
cirrhotic with non infected ascitis.
There was significant increase in AF
level of VEGF in cirrhotic group as well
as SBP group but plasma value did not
differ between both groups of patients.
The ascitic fluid PMN and sL-selectin
were higher in culture positive SBP
patients particularly in these with gram
positive isolate but there are non
significant increase in ascitic fluid
level of VEGF in culture positive SBP
than culture negative cases.
Positive correlation was found between
serum and ascitic fluid level of ICAM-1
in SBP and non infected cirrhotic group.
Also positive correlation was found
between VEGF levels in serum and ascetic
fluid levels in both cirrhotic group SBP
and non infected cirrhotic group.
Conclusion: Significant elevated
level of VEGF in both SBP and non
infected cirrhotic patients may have
pathophsiological consequences of local
regulation of vascular tone and
endothelial permeability and significant
elevated level of adhesion molecules in
both SBP and non infected cirrhotic
patients are due to inflammatory
response and endothelial cell
activation. Serum and ascetic fluid of
ICAM-1 can be used as useful markers for
diagnosis of SBP and for monitoring the
treatment of cirrhotic patients.
Dr.
Zainab O. Fawzi
Survey of Hepatitis
markers Among Donors In Qatar
Dr.
Zainab O. Fawzi, Ms. Aysha Al- Malki,
Ms. Hamda Al Mutawa
We surveyed the results of hepatitis
markers screening tests of all blood
donations collected over a period of 8
years (Jan. 1994 – Dec. 2001). All
donations were collected by the Blood
Donor Unit at Hamad Medical Corporation
which is the only blood collection
center in Qatar.
A total of 78428 donations were screened
for hepatitis markers, of which 28622
(35.5%) were donated by Qatari nationals
and 49806 (6305%) were donated by non-
Qatari residents of various
nationalities. Out of those 16228 units
(20.69%) were discarded for various
reasons. 10382 units (63.98% of total
discard, 13.2% of donations) were
discarded because of positivity for one
or more hepatitis markers. Of all
donations 769 units (0.98 % of total
donations, 4.7 % of total discard, 7.4 %
of hepatitis positive discard) were
positive for HbsAg, 8516 units (10.85 %
of total donations, 52.47 % of total
discard , 82.02% of total hepatitis
positive discard) were positive for
HbcAb and 1097 units (1.39 % of total
donations, 6.7 % of total discard, 10.57
% of total hepatitis positive discard)
were positive for HCV antibodies.
Results of Qatari donations were
analyzed in comparison with the results
of non- Qatari donations collectively
and with the results of selected
nationalities, which had contributed
significantly larger number of
donations.
There is no significant difference
between the rate of positivity for HbcAb
between Qatari donations and non- Qatari
donations taken collectively, however
there is a slightly higher rate of
positivity for HbsAg in the first group
and slightly higher rate of positivity
for HCV antibodies in the later group.
An outstanding finding is the
significantly higher rate of positivity
for HCV antibodies in Egyptian donations
seen in 11.2% of all Egyptian donations
and accounting for 31.2% of all discards
for this group.
Materials and Methods:
The results of hepatitis screening tests
performed on all donations collected by
the donor unit at Hamad Medical
Corporation (HMC) over a period of eight
years (Jan. 1994 – Dec. 2001) were
analyzed to look at the rate of
positivity of hepatitis markers among
the multinational donor population in
Qatar. A total of 78428 donations were
screened 28622 of which were donated by
Qatari nationals and 4680 residents of
different nationalities. All donations
were screened for hepatitis – B surface
antigen (HbsAg), hepatitis –B core
antibody (HbcAb) and hepatitis- C (HCV)
antibodies. All units which are HbsAg
negative and HbcAb positive are also
screened for hepatitis – B surface
antibodies however these results is not
included in this analysis. We analyzed
the results of the total group
collectively and then we looked
separately at the results of the
donations made by Qatari nationals and
non- Qatari donors collectively and at
the results of donations made by
selected groups donors of certain
nationalities that had contributed a
significantly larger numbers of
donations.
Results:
The results of 78424 donations were
analyzed and the results of the total
group are summarized in table 1.
Dr .
Ajayeb Al Marri
Genotype Distribution of
Hepatitis C Virus in Qataries
Title: Genotype Distribution of
Hepatitis C Virus in Qataries
Abstract: Genotype Distribution
of Hepatitis C Virus in Qataries
Background: As there are 6 known
genotypes and more than 50 subtypes of
HCV. The hepatitis C virus (HCV)
genotypes distribution in the Qataries
are unknown. The purpose of our study is
to determine the prevalent of HCV
genotypes among HCV positive Qataries
patients,Knowing the genotype of HCV is
considered one of the most important
predictors of treatment response, and
allow rational decisions regarding
duration of treatment. Patients and
Methods: 146 subjects who are positive
for HCV- RNA by PCR, using the COBAS
AMPLICOR (Roche Diagnostics). HCV
genotyping was performed in serum
samples by a reverse hybridization assay
(INNO-LiPA HCV II, second generation,
Innogenetics), in which a reverse
transcriptase-polymerase chain reaction
(RT-PCR) product of the 5'untranslated
region (5'UTR) is hybridized with probes
from various HCV genotypes. Results: The
genotyping results of the 146 HCV
isolates, on the basis of the line
probe, are shown (Table 1). Four
different types were found, and their
overall prevalence was for type 1- 64
cases (44%); with the following subtypes
1a (11%); 1b (52%); two cases within
types (1a + 1b), and 34% could not
differentiate the subtype. 13 cases (9%)
for type 2 with the following subtypes:
2b (8%); 2a/2c (31%) and (62%)
undifferentiated subtypes. Type 3 was
identified in 27 cases (18%) with the
following subtypes: 3a (67%), 3b (30%)
and 4% undifferentiated subtype.
Finally, 42 cases (29%) showed type 4,
with the following subtypes; 4a (2%), 4b
(2%), 4c/4d (38%), 4e (7%) and 4h (2%)
Conclusion: Type 1 (44%) is the most
predominant HCV type in Qataries. Where
Subtype 1b was encountered in 33 (47.6%)
patients out of 64 identified. Followed
by type 4 and type 3 (29% and 18%). This
genotype distribution differs from the
neighboring countries; Saudi Arabia and
Kuwait where genotype 4 is the most
prevalent genotype as well as in the
central, North Africa and the Middle
East. In contrast, subtype 1b is found
in Japan, Western Europe also identified
as the most prevalent in the Indian
subcontinent, Pakistan and Turkey. The
clinical implications of these genotypes
will be discussed
Dr.
AhmedIsmail
Screening for viral
hepatitis infections among expatriates
population seeking employment in Qatar:
Challenges and Recommendations
MBBS, MD Clinical Path., DTM&IH, PhD
Organization/institution: Qatar General
Medical Commission, National Health
Authority, Doha, Qatar.
Mailing address: Dr. Ahmed Ismail,
Consultant and Lab. Head,
Laboratory Department, Qatar General
Medical Commission,
National Health Authority,
P.O. Box 2743, Doha, Qatar.
Email:
aicmp@yahoo.com
Postal Code: P.O. Box 2743
City: DOHA
Country: QATAR
Tel: Mobile: + 974 5207067/ Pager:
2102984 / Office: + 974 4663908
Fax: +974 4663239
E-mail:
aicmp@yahoo.com
Title: Screening for viral
hepatitis infections among expatriates
population seeking employment in Qatar:
Challenges and Recommendations
Abstract: Abstract: Hepatitis B
and C are blood borne liver diseases,
caused by the hepatitis B (HBV) and C
(HCV) viruses, respectively. They have
become an important public health issue
in some parts of the world because of
their high prevalence, complications and
ongoing transmission. HBsAg and Anti-HCV
testing is performed in multiple
settings, including hospitals, other
health-care facilities, public health
laboratories and employment sites. The
Qatar General Medical Commission, as in
other Gulf Cooperation Council (GCC)
countries, plays a major role in
controlling the infectious diseases
through examining expatriates coming for
employment and to visit Qatar. Screening
for HBV and HCV infections is performed
on individuals who constitute high
transmission risk. During the last 6
months screening for HBV and HCV was
carried out on approximately 15,000 out
of 121,000 referred to the Medical
Commission for screening for infectious
diseases. Those individuals who were
tested came from different countries
with different prevalence of the
disease. In a setting like the Medical
Commission the interpretation of HBsAg
and anti-HCV positive results can be
challenging, especially in individuals
who are asymptomatic and without prior
knowledge of their past medical history.
Thus, the accuracy of a
screening-testpositive result for any
given specimen cannot not be verified
unless serial testing and additional
tests are performed. Consequently
specimens would be having a longer turn
around time for testing and costly. In
this study the prevalence of HBV and HCV
infections among expatriates seeking
employment in Qatar will be presented.
In addition the guidelines and
laboratory algorithm (flow chart) for
screening for HBV and HCV implemented by
the Medical Commission will be
discussed. Furthermore, challenges
facing the Medical Commission in
diagnosing viral hepatitis and future
recommendations will be highlighted.
Dr Izzat a m khanjar
Organization/institution: H M C
Mailing address: po box 3050
Postal Code: 3050
City: Doha
Country: Qatar
Tel: 4392874
Fax: 4803477
E-mail:
ikhanjar@hmc.org.qa
Hepatic manifestation of Rheumatic
disease ( as a free lecture approximatly
30-45 minutes )
Abstract: some of systemic rheumatic
disease up to more than 20% in some one
such as SLE may present with hepatic
manifestation during its course like
hepatoslenomegaly and elevated liver
enzyme ,occationally jaundice ,sofar
mony different patterns might present
either as CAH , fibrosis , PBC
,cirrhosis and Nodular regenerative
hyperplasia and also steatosis in same
other cases ,serology and imaging in
addition to liver biopsy may needede to
get the diagnosis , immunosupressive and
GCS the main treatment of this condition
as part of main rheumatic diseases .( we
will not discusse her the rheumatic
manifestation of Hepatitis or related
drugs because need another took )
Infection control
guidelines in dental treatment of
patients with viral hepatitis
Dental health-care personnel might be
occupationally exposed to infectious
materials, including body substances and
contaminated supplies, equipment,
environmental surfaces, water, or air.
Dental health-care personnel include
dentists, dental hygienists, dental
assistants, dental laboratory,
technicians, students and trainees, and
other persons not directly involved in
patient care but potentially exposed to
infectious agents (e.g., administrative,
clerical, housekeeping, maintenance, or
volunteer personnel).
Viral hepatitis is one of the most
common (and dangerous) infectious
diseases that might be transmitted
between patients and health workers.
Dental settings can transmit hepatitis
virus through:
1) Direct contact with blood, oral
fluids, or other patient materials
2) Indirect contact with contaminated
objects
3) Contact of conjunctival, nasal, or
oral mucosa with droplets containing
microorganisms generated from an
infected person and propelled a short
distance.
4) Inhalation of airborne microorganisms
that can remain suspended in the air for
long periods
The aforementioned modes of transmission
necessitate the implementation of strict
guidelines for infection control in the
dental health care practice.
The aim of this presentation is
summarize the clinical measures required
to prevent and / or reduce potential for
infectious disease transmission.
Shabani Ali Akbar
Organization/institution: Center for
Biotechnology Research, Semnan
University of Medical Sciences, Mailing
address: Postal Code: 36716 76149, City:
Semnan
Country: Iran, Tel: 98 231 3334052 Fax:
98 231 3331551
E-mail:
shaebani@sem-ums.ac.ir
Evaluation of HCV infection in a Afghan
Refugee camp, Semnan, Iran
Abstract: Evaluation of HCV infection in
a Afghan Refugee camp, Semnan, Iran
Shabani Ali Akbar, Akbari Eidgahi,
Mohammad Reza, , Hadjighorbani Amir
Hosein Center for Biotechnology
Research, Semnan University of Medical
Sciences and Semnan Management and
Programing Org, Semnan, Iran Hepatitis C
virus (HCV) infection is a major cause
of chronic liver diseases in the world.
There is a little information about HCV
infection in Afghanistan and
substantially in Afghan refugees. In a
preliminary report from a blood
transfusion center at Kabul prevalence
HCV is 0.3%. This rate is equal to
prevalence of infection in Iranian
normal population. In this study, we
investigated the prevalence of serumic
and genomic markers of HCV infections in
Afghan refugee settled in Semnan camp,
Iran at 2004. Materials and Methods:
Preserved sera from 368 randomly
selected adult subjects obtained in
another study were tested for HCV
antibody (ELISA III, DIA.PRO, Italy) and
alanine aminotransferase (ALT) level.
Anti-HCV positive samples were further
tested by two RT-PCR based commercial
kits for viral genome to determine
active infection.. Results: All of 368
serum samples were normal for ALT. Anti-HCV
antibody was positive in 2 (0.5%)
subjects, however both of them were
negative for viral genome when tested by
RT-PCR using both two commercial kits.
Conclusion: However we don't have any
information about the HCV infection in
Afghan Refugees settled in Semnan camp
when they arrived to Iran but we showed
the prevalence of HCV infection is low
after more than two decades. The anti-HCV
positive individuals didn't have active
HCV infection as jugged based on RT-PCR
results. It may be due to a formerly
infection and clearance of virus from
blood, a false-positive serologic result
or undetectable genotype of virus.
Finally we concluded the encampment
conditions are not a risk factor for HCV
infection.
DR. DIANA
KAYAL
MANAGEMENT of HCV and HBV INFECTED WOMEN
Dr. Badreldeen Ahmed, Dr. Diana Kayal
Chronic hepatitis C or B can lead to
liver cirrhosis and hepatocellular
carcinoma, these infections are not a
contra-indication to pregnancy and can
be transmitted to the child during
delivery.
Hepatitis B is one of the most highly
transmitted forms of hepatitis from
mother to child especially in the
developing countries. The transmission
of hepatitis B virus to the neonate
occurs in 10-20% of cases if the woman
is seropositive for HbsAg and in 90% of
cases if the woman is both HbsAg and
HbeAg positive.
Mother to child transmission of
hepatitis C has been reported in up to
10% of cases and is higher in women who
are also infected by HIV.
Screening for hepatitis B surface
antigen is mandatory for all pregnant
women so that postnatal intervention can
be offered to decrease mother to child
transmission.
At this time there is no preventive
treatment that can influence the rate of
transmission of hepatitis C virus from
mother to child, therefore hepatitis C
antibody screening should only be
offered to women with other associated
risks.
Delivery by cesarean section for the
purpose of reducing mother to child
transmission is currently, not
recommended neither for hepatitis B nor
for hepatitis C.
Breastfeeding doesn’t in both cases
increase the risk of transmission to the
neonate.
Although pregnancy will not change the
course of most forms of hepatitis, there
appears to be a higher incidence of low
birth weights, an increased risk of
gestational diabetes mellitus,
antepartum hemorrhage and threatened
preterm labor among HbsAg carriers.
Akbari Eidgahi Mohammad Reza
Organization/institution: Center for
Biotechnology Research, Semnan
University of Medical Sciences , Mailing
address: Km 5 Damghan road, Faculty of
Medicine, Seman, Iran, Postal Code:
91836 53891, City: Seman
Country: Iran
Tel: 98 231 3334052 Fax: 98 231 3331551
E-mail:akbari@sem-ums.ac.ir
Prevalence of hepatitis B virus
infection in an Afghan refugee camp,
Semnan, Iran
Abstract: Prevalence of hepatitis B
virus infection in an Afghan refugee
camp, Semnan, Iran Akbari Eidgahi
Mohammad Reza, Shabani Ali Akbar,
Hadjighorbani Amir Hosein, Hosseini
Moghaddam Neshat Center for
Biotechnology Research, Semnan
University of Medical Sciences and
Semnan Management and Programing Org,
Semnan, Iran akbari@sem-ums.ac.ir
Hepatitis B virus (HBV) infection is a
major cause of chronic liver disease in
the world. There is a little information
about HBV infection in Afghanistan and
substantially in Afghan emigrants to
Iran. In this cross-sectional study, we
aimed to investigate the prevalence of
serumic markers of HBV infection in
Afghan refugee settled in Semnan camp at
year 2004. Materials and Methods: A
total of 368 unvaccinated adults (>15
years old) of both sexes (170 male and
198 female) randomly selected. They had
been settled in this camp at least for
two decades. All subjects were examined
for HBsAg, HBsAb and HBcAb using Elisa
to determine any formerly exposure to
HBV infection. All positive subjects for
HBsAg or HBcAb alone were further
examined for HBeAg/Ab using Elisa. All
samples were tested for Alanine
aminotransferase (ALT) for evaluation of
liver function. Results: Of 368
individuals, all of them had normal ALT
and 236 (64.1%) had evidence of exposure
to HBV as judged by at least on of
serologic markers. 144(39.1%) of them
had antibody against HBsAg suggesting
previous exposure to and acquiring
immunity against HBV virus. In 19.4% of
HBsAb positive subjects there was no
HBcAb. Rate of exposure was
significantly higher in females and in
older subjects. 49(13.3%) were HBsAg-positive
carrier and the positive rate for HBcAb,
HBeAg, and HBeAb were 98.2%, 8.2% and
75.5% respectively. Presence of HBsAg
had no significant correlation with sex,
age, marriage, and also with previous
transfusion reception, surgery or
dentistry. Of 368 subjects, 207 (56.3%)
were HBcAb positive and among them 43
(20.8%) were positive for HBcAb but not
for both HBsAg/Ab. Results had been
shown in table. no HBsAg HBsAb HBcAb
HBeAb HBeAg ALT 132 - - - ND ND N 1 + -
- - - N 4 + - + - + N 3 + - + - - N 4 +
- + - - N 10 + - + + - N 27 + - + + - N
28 - + - ND ND N 116 - + + ND ND N 9 - -
+ - - N 27 - - + - - N 1 - - + + - N 6 -
- + + - N 386 49 144 207 44 4 368 N:
normal, ND: not determined Conclusion:
We showed HBV infection in Afghan
Refugees settled in Semnan camp is
highly prevalent. Both exposure to the
HBV infection and chronic carriers
status in this group are significantly
higher than Iranian population (64.1% vs
35%) and (13.3 vs 1.7-5%) respectively.
We have estimated in this group,
20.8-23.2% of individuals become chronic
carriers after exposure to HBV
infection. This rate is significantly
higher than Iranian normal population in
which rate of 8% has been estimated.
High rate of chronicity show prenatal
transmission or lower age infection is
common in this encampment conditions. We
also showed there are no significant
differences for replicative form of
chronic infection (as judged by a
positive HBeAg) between Iranian
population and study group. In
conclusion we showed afghan refugees are
a high prevalent population for HBV
infection with high chronicity rate.
Ms. Samera Abdulla
Hepatitis C supplemental test (RIBA),
Challenging and recommendation
Authors: Samera Abdulla, Moza El khinji
and Ajayeb Al Marri
Immunology lab, HMC.
Doha- Qatar.
e-mail:ahubisha@hmc.org.qa
Background: We test all samples with various liver
disease received in our lab from August
2004 – June 2005 using Chemiluminescent
Microparticles Immunoassay (CMIA)
(Abbott laboratories).
For any sample found repeatedly reactive
by HCV assay, stratified by
signal-to-cutoff (S/CO)ratio,
supplemental testing; RIBA (Chiron RIBA
HCV 3.0) and/or PCR (Roche diagnostic
system), will be carried out. Currently,
in our lab RIBA is performed when the
S/CO ratio id repeatedly < 3.8 , if the
RIBA was indeterminate, test kit
instructions recommend re-testing in
6-12 months to ascertain whether
increased reactivity has occurred.
Our Results:
323 samples were found repeatedly
reactive for HCV by CMIA, Which divided
into two groups according to S/CO ratio.
Group 1: Strongly reactive with >3.5
S/CO ratio.
Found in 19% (62/323), fig (1). RIBA
test results for this group are shown
(fig.2), with the following results; 56%
(35/62) were positive, 42% (26/62) were
indeterminate & 1% (1/62) was negative.
Group 2: Weakly reactive with < 3.5 S/CO
ratio.
Found in 80% (261/323), fig (1), RIBA
results showed 203/261 (78%) were
indeterminate, 20% (52/261) were
negative & 2% (6/261) were positive, fig
(3).
Out of this 323HCV patient samples, only
107 were tested for PCR, results shown
in fig(4).
Discussion: Among strongly reactive specimens ( >3.8
S/CO) that were PCR negative, none were
RIBA negative and 61% (8/13) were
indeterminate, fig (4). Thus, a strongly
reactive CMIA screening test results is
predictive of a positive RIBA results,
and precludes the need to perform RIBA
testing to confirm antibody status.
Conversely, among weakly reactive
specimens (< 3.8 -S/CO) that were PCR
negative, 5% (4/73) were RIBA negative
and 93% (68/73) were indeterminate. Only
0.01% (1/73) were RIBA positive. Thus a
weakly reactive CMIA test results is
predictive of a negative or
indeterminate RIBA result. Interpreting
HCV supplemental test results can be
challenging. A positive HCV-PCR test
indicates that virus is currently
present in the blood. A positive RIBA
test indicates that HCV antibody is
present in the blood; however, infection
with HCV may be current or resolved. PCR
testing is still needed to confirm
active infection. This ambiguity makes
RIBA tests clinically useful than PCR
tests. In addition to clinical
usefulness, the decision to use a
supplemental test should take into
account test cost and the likelihood of
a definitive results. RIBA test is
expensive to perform (QRS 365). The
overall likelihood of a definitive
results is quite low. As well, test-kit
instructions recommend retesting
indeterminate specimens in 6-12 months.
If follow up tests are also
indeterminate, continued re-testing is
recommended with no definitive
interpretation of results. The cost of
the sample depend on algorithm testing
CMIA - RIBA - PCR = QRs 694, while the
cost of the sample depend on testing
CMIA - PCR = QRs 412. The costs saving
in this diagnostic algorithm are
remarkable and take less than five days
to confirm a current infection.
Conclusion:
Our results suggest that RIBA test often
do not contribute to characterizing a
patient HCV status. These data are
consistent with other supplemental test
results analysis from published reports.
Based on the analysis of HCV test
results, the decision was to discontinue
RIBA testing and the new HCV test
algorithm will be discussed.
