Yousif Monkez M, Elsadek Fakhr Ahmed, Morad Emad A, Kelani Hesham, Hamed Emad F, Elsadek Hany M, Zahran Mahmoud H, Fahmy Afify Afify, Ismail Waleed A, Elagrody Ahmed I, Ibrahim Nevin F, Amer Fatma A, Zaki Ayman M, Sadek Ayman M E M, Shendi Ali M, Emad George, Farrag Hesham A
Internal Medicine Department, Zagazig University, Sharkia, Egypt.
Microbiology and Immunology Department, Zagazig University, Sharkia, Egypt.
Infez Med. 2018 Sep 1;26(3):237-243.
The reappearance of HCV infection months or years after sustained virologic response (SVR) may be due to the persistence of HCV in tissue cells in spite of being undetected in serum. This situation is known as occult hepatitis C infection (OCI). We aimed to assess the prevalence of OCI in Egyptian patients with chronic hepatitis C (CHC) who achieved SVR after treatment with direct-acting antiviral agents (DAA). We carried out a cross-sectional study at the Advanced Center for Liver Diseases of Zagazig University Hospitals and Al-Ahrar Viral Hepatitis Treatment Center, Sharkia Governorate, Egypt. One hundred and fifty adult patients with CHC, who achieved SVR 12-24 weeks after end of treatment with sofosbuvir/daclatasvir ± ribavirin (139 patients, 92.67%), sofosbuvir/ledipasvir ± ribavirin (eight patients, 5.33%), sofosbuvir/simeprevir (two patients, 1.33%), and ombitasvir/ paritaprevir/ritonavir + ribavirin (one patient, 0.67%), according to the Egyptian National Committee for Control of Viral Hepatitis, were included in the study. We tested these patients for HCV RNA in peripheral blood mononuclear cells (PBMCs) immediately after confirmation of SVR12-24 weeks. Statistical analysis was performed by means of the Shapiro-Wilk test, Mann-Whitney U test, Chi-square test, and Fisher's exact test. Seventeen patients (11.33%) were positive for PBMNCs HCV RNA. The prevalence of OCI was highest in patients treated with simeprevir/sofosbuvir (2/2 patients). There is a substantially high prevalence of OCI after treatment with DAAs. We recommend dual testing for HCV RNA in both serum and PBMCs at the end of treatment of HCV infection with DAAs and during validation of the SVR following the initial response.
在持续病毒学应答（SVR）数月或数年之后丙型肝炎病毒（HCV）感染再次出现，可能是由于尽管血清中未检测到HCV，但组织细胞中仍存在HCV。这种情况被称为隐匿性丙型肝炎感染（OCI）。我们旨在评估在接受直接抗病毒药物（DAA）治疗后实现SVR的埃及慢性丙型肝炎（CHC）患者中OCI的患病率。我们在埃及扎加齐格大学医院肝病高级中心和东部省阿拉尔病毒性肝炎治疗中心开展了一项横断面研究。根据埃及国家病毒性肝炎控制委员会的标准，纳入了150例CHC成年患者，这些患者在使用索磷布韦/达卡他韦±利巴韦林（139例患者，92.67%）、索磷布韦/来迪派韦±利巴韦林（8例患者，5.33%）、索磷布韦/西米普明（2例患者，1.33%）和奥比他韦/帕立普韦/利托那韦+利巴韦林（1例患者，0.67%）治疗结束后12 - 24周实现了SVR。在确认SVR 12 - 24周后，我们立即对这些患者的外周血单个核细胞（PBMC）进行HCV RNA检测。通过Shapiro-Wilk检验、Mann-Whitney U检验、卡方检验和Fisher精确检验进行统计分析。17例患者（11.33%）的PBMNCs HCV RNA呈阳性。使用西米普明/索磷布韦治疗的患者中OCI患病率最高（2/2例患者）。使用DAA治疗后OCI患病率相当高。我们建议在使用DAA治疗HCV感染结束时以及在初始应答后SVR验证期间，对血清和PBMC中的HCV RNA进行双重检测。
