Internal Medicine Department.
Internal Medicine Department, Faculty of Medicine and Clinical Pathology Department.
Eur J Gastroenterol Hepatol. 2021 Jul 1;33(7):1009-1014. doi: 10.1097/MEG.0000000000002075.
Occult hepatitis C infection is defined as the presence of hepatitis C virus RNA in peripheral blood mononuclear cells (PBMC) ± hepatocytes in the absence of HCV-RNA in serum. It has been a lot of debate and controversy in recent years and not discussed well. This issue has not been discussed or investigated in Egypt, especially in patients on hemodialysis in Ismailia. This study is the first one to investigate the prevalence of occult HCV infection in large populations of chronic hemodialysis (CHD) patients in Ismailia, Egypt.
Our study is cross-sectional analytic and included 204 CHD patients; who are negative for HCV infection. Sensitive commercial real-time assay was used to detect HCV-RNA in PBMC. In our study, the presence of genomic HCV-RNA in PBMCs of all these patients was detected by real-time PCR. On the other hand, 22 patients on hemodialysis with an established diagnosis of chronic hepatitis C virus infection were included as a control group and examined by real-time PCR was used to evaluate HCV infection.
Occult HCV infection is defined as the presence of HCV-RNA in PBMNCs in patients on chronic hemodialysis, and it was found in 14/204 (7%) of the patients. Patients who were on CHD for a longer time are susceptible to occult HCV infection, and their mean alanine aminotransferase levels are significantly higher during the last 3 months before study entry. In comparison, chronic HCV patients have elevated bilirubin, aspartate transferase and alanine transferase than occult HCV infection.
The prevalence of occult HCV infection was 7% in our CHD patients. No available data are showing the virulence of this form of virus. However, further studies in other geographic populations with high HCV endemicity are needed to clarify the significance of occult HCV infection in these patient groups, in addition to test for the presence of negative antigenomic strand to confirm or disconfirm the reliability of occult HCV.
隐匿性丙型肝炎感染定义为外周血单核细胞（PBMC）中存在丙型肝炎病毒 RNA，而血清中不存在 HCV-RNA。近年来，这一问题引起了广泛的争议，但尚未得到充分讨论。在埃及，特别是在伊斯梅利亚的血液透析患者中，尚未对此问题进行讨论或调查。本研究首次调查了埃及伊斯梅利亚地区大量慢性血液透析（CHD）患者隐匿性 HCV 感染的流行情况。
我们的研究是一项横断面分析，纳入了 204 例丙型肝炎病毒阴性的 CHD 患者。采用敏感的商业实时检测法检测 PBMC 中的 HCV-RNA。在本研究中，通过实时 PCR 检测所有这些患者 PBMC 中基因组 HCV-RNA 的存在。另一方面，纳入 22 例经血液透析确诊为慢性丙型肝炎病毒感染的患者作为对照组，并通过实时 PCR 进行检查。
隐匿性 HCV 感染定义为慢性血液透析患者 PBMC 中存在 HCV-RNA，在 204 例患者中有 14 例（7%）存在。接受 CHD 治疗时间较长的患者更容易发生隐匿性 HCV 感染，在研究开始前的最近 3 个月内，其丙氨酸氨基转移酶水平显著升高。相比之下，慢性丙型肝炎患者的胆红素、天门冬氨酸转氨酶和丙氨酸转氨酶水平高于隐匿性 HCV 感染患者。
我们的 CHD 患者中隐匿性 HCV 感染的患病率为 7%。目前尚无数据表明这种病毒的毒力。然而，需要在其他 HCV 高流行地区的人群中进行进一步研究，以阐明隐匿性 HCV 在这些患者群体中的意义，并检测阴性反义链的存在，以确认或否定隐匿性 HCV 的可靠性。
