Prevalence of Silent Hepatitis Band HCV Genotype Among Chronic Hepatitis C Patients

This multi-center study was designed as a trial to explore the prevalence of silent hepatitis B infection among hepatitis C patients and to determine the prevalent genotype of hepatitis C virus (HCV) in these patients. The study comprised 45 patients with post-hepatitic liver cirrhosis. All patients gaveblood samples for estimation of liver function tests, ELISA estimation of serum levels of hepatitis B surface antigen(HBsAg), anti-HCV antibodies and HCV core antigen, patientswith HBsAg positive were excluded off the study. Qualitativedetection of HCV RNA and HBV DNA by PCR (home-madePCR) and Quantitative PCR for estimation of HCV viremiaand HCV genotyping: by REFLP technique were performed.The HCV-Ab was detected in all and HCV-Ag in 42 samples(93.3%) irrespective of its clinical severity class with a meanviremia level of 792336.7±400074.8; range: 134985-1957632viral copy/ml as determined by quantitative PCR. There wasa non-significant difference between severity clinical classesas regards the qualitative or quantitative detection of HCVinfection. The HBV DNA was detected using qualitative PCRin 20 samples (44.4%); 4 class A, 7 class B and 9 class Csamples with a significant increase of the frequency of silentHB in patients with class B (X2=5.446, /? 0.01) and C(X2=8.154, /? 0.001) in comparison to class A patients. Genotypingof HCV reported 41 samples (91.1%) with genotype-4 and 4 samples (8.9%) with genotype-1 with a prevalencerate of HCV genotype-4 was 91.1%. There was positive nonsignificantcorrelation between both HCV genotype and thepresence of silent hepatitis B infection and clinical severity,however, using the receiver operating characteristic (ROC)curve analysis judged by the area under the curve (AUC) toevaluate the sensitivity and specificity of detection of silenthepatitis B infection and identification of HCV genotype aspredictors of severe hepatitis showed a non-specific role forgenotyping for prediction of severity with AUC=0.467, whilethe detection of HBV DNA using PCR in patients with HCVinfection is a specific predictor of severity with AUC=0.617.It could be concluded that HCV genotype-4 is the mostprevalent type in Egyptian Hepatitis C cirrhotic patients witha prevalence of silent hepatitis B of 44.4% and its detectionis a specific predictor of severe cirrhosis.