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P.150 Anti-HCV profile in serum specimens from HCV infected patients coinfected with opportunistic diseases
Posters: 02a. Hepatitis C - diagnosis
Aim: To study the hepatic histopathological features in genotype 4 chronic HCV and their relation to demographic, clinical and laboratory features. Methods: This study included 200 patients with serologic and virologic diagnosis of chronic HCV. HCV genotyping was performed. Percutanious liver biopsy was performed to all patients. Scoring system of Ishak et al., 1995 was applied for assessment of fibrosis stage and necroinflammatory injury with iron staining. The relation between histological features and demographic, clinical, and laboratory features was studied. Results: Two hundred patients with mean age 39.5± 8.7 years, range 20-58, 158 (79%) male were included. Liver biopsy examination showed that only 28 (14%) had cirrhosis. Most of our patients (125; 62.5%) revealed no or only portal tract expansion by fibrosis. Stage of fibrosis is significantly correlated with ALT, AST, platelet count and direct bilirubin. For necroinflammatory injury, most of our patients (130; 65%) had mild activity, and only 4 patients had marked activity. Degree of inflammatory activity is correlated with ALT level. Steatosis was found in 52% of our patients with marked degree in only 8 patients (4%). Four biopsy specimens were found positive for schistosomiasis. Hemosedrosis was detected in 15% of the examined specimens, most of them of mild type. Conclusions: (1) Chronic HCV genotype 4 has a lower possibility of cirrhosis at presentation and lower incidence of hemosedrosis than other genotypes. (2) Steatosis associating genotype 4, may be similar to that of genotype 1 rather than genotype 3. (3) No significant effect of schistosomal infection on histopathological changes. (4) ALT is significantly correlated with degree of inflammatory activity and stage of fibrosis, however, AST, platelet count, and bilirubin level are correlated with stage of fibrosis. ~
Anti-HCV profile in serum specimens from HCV infected patients coinfected with opportunistic diseases
G.B. Bochkova*, D.A. Polushina, L.V. Kulikova, S.N. Fomina, A.N. Burkov, A.R Obriadina, ]11. Ulanova. Scientific, RPC
Diagnostic systems, Nizhny Novgorod, Russian Federation Background and Objectives: One of the problems of EIA diagnostic hepatitis C infection (HCV) is associated with the reliable verification screening assays results. Serum samples from HCV infected patients with coinfections may present with atypical results in serological tests. The purpose of the present study was to evaluate the antibody profile of serum specimens from HCV infected patients coinfected with opportunistic diseases. Methods: The correlation of anti-HCV antibody profile with presence antibodies to TORCH infections in sera from coinfected patients has been investigated. Well defined anti-HCV positive serum samples (n = 162) were additionally tested on presence of anti-lgG, IgM, IgA to Toxoplasma gondii and Chlamydia trachomatis; anti-lgG to HSV-1 and HSV-2, anti-lgG, IgM to CMV and anti-VCA IgG, antiVCA IgM, anti-EA, anti-EBNA. As a control group, anti-HCV negative serum samples from healthy blood donors have been used (n = 247). All data were statistically processed. Results: It has been shown that anti-Toxo IgG in the anti-HCV positive serums meet twice less often than in serums of healthy donors (p >0.995). Besides this in serum samples with antibodies to all HCV proteins or with antibodies to three HCV proteins (core, NS3 and NS4) the lower concentration anti-lgG to HSV-1 and HSV-2 is observed (p>0.966). Moreover, it has been revealed that in specimens containing antibodies to the structural protein of HCV as a unique marker of infection or in a combination with antibodies to nonstructural HCV proteins the twice lower concentration of antibodies to a capside antigen (VCA) of the Epstein-Barr (EB) virus is observed (p>0.95). In specimens containing antibodies to the core protein of HCV in a combination with NS4 HCV the concentration of antibodies to the NA antigen of EB virus was one and a half time more than in samples from the control group (p > 0.902). Anti-NS3 is a unique marker of the HCV infection presented in 45% of anti-lgA and 31% of anti-lgG Chlamydia trachomatis positive sera. The combination of anti-NS3 with anti-core or combination of anti-nonstructural HCV proteins only were observed in 55% of
$107 anti-lgA and 69% of anti-lgG Chlamydia trachomatis positive sera (p > 0.995). Other statistically significant correlations have not been revealed. Conclusion: There is bidirectional influence of the hepatitis C virus and opportunistic infections. Serum specimens from HCV patients coinfected with TORCH infections very often have no complete HCV-antibody spectrum.
IP•
Hepatitis C prevalence with normal serum alanine aminotransferase in a cohort analytical study of population referred to Iranian Red Crescent clinic in Azerbaijan Republic
N. Farhadi 1, M. Najafizadeh 2 *, Z. Karayev3. 1Physiology, Yasouj
University of Medical Sciences, Yasouj, Iran, 2Immunology and allergy, 3Microbiology and Immunology, Azerbaijan Medical University, Baku, Azerbaijan Background and Objectives: It is estimated that about 3.0% of the world's population have HCV. In 1998, the estimated annual costs of acute and chronic hepatitis C was above US$1 billion in the USA. A clear distinction among the different types of viral hepatitis cannot be made solely on the basis of epidemiological features and also ALT levels in hepatitis C according to recent research results. This study is aimed to determine of prevalency of hepatitis C and serum ALT normalization in patients. Methods: in this analytical descriptive study 1908 (44.3% M, 55.7% F) persons 11 to 93 years of age (M=43.33, SD=14.07) were selected by sequential sampling method according to ,Y,=5%, 15= 20%. Samples were from various regions of Azerbaijan Republic. Hepatitis C Virus infection was confirmed by two times positive AntiHCV test. Serum ALT titration was performed for 44 patients with positive test. Data were analysed by Student's T-test (one-sample, independent) and ~2 tests with SPSS 11.5 software. Results: Prevalence of hepatitis C in this study was 3.9% (male: 4.0%,female: 3.8%), significantly different from the world mean. ALT level was normal in 47.7% (male: 60.0%, female: 37.5%) of patients with hepatitis C. There was no statistically significant difference between gender and age group in results (p >0.05). Conclusion: We conclude that prevalence of hepatitis C in a part of Azerbaijan Republic population (3.9%) is 0.9% greater than world mean (3.0%). In over 40% of cases the risk factor(s) cannot be identified. In other cases they may be due to many reasons of contact with contaminated blood, especially blood products, hemodialysis, hemophiliacs, injecting drug and unsterile medical or dental equipment. Also we suggest that patients with hepatitis C virus infection may have normal ALT levels thus histopathology grade and stage of liver damage is not reflected by serum ALT levels. [ - ~ - ~ 1 Anti-HCV IgG avidity index in acute hepatitis C N. Coppola 1, R. Pisapia 1, S. Martini 1, C. Marrocco 1, L. Vatiero 1, V. Messina 2, G. Tonziello2, C. Sagnelli 1, R Filippini 1, E Piccinino 1, E. Sagnelli 1 *. 1Public Medicine, Second University of Naples,
Naples; 2Infectious Diseases, San Sebastian Hospital, Caserta, /ta/y Background and Objectives: In this study we evaluated the usefulness of detecting the anti-HCV IgG Avidity Index (HCV AI) to distinguish AHC from r-CHC by investigating 40 consecutive patients with AHC and 37 consecutive patients with r-CHC. Methods: We enrolled 40 consecutive patients with AHC documented by seroconversion to anti-HCV and 37 consecutive patients with r-CHC. Forty patients with chronic hepatitis C (CHC) were also investigated. The HCV AI was determined by an ELISA on patients'sera 1:10 pre-diluted with 1 M guanidine. Results: On admission the HCV AI values were significantly lower in the AHC group (mean±SD: 0.50±0.30) than in the r-CHC group (0.94±0.25, p < 0.0001) and the CHC group (1.06±0.20, p < 0.0001), but no cut-off value distinguished AHC from r-CHC. An increase in HCV AI of at least 20% during the acute phase of the illness, considered sign of acute HCV infection, was observed in 24 (72.7%) of the 33 patients in the AHC group having a follow-up and in 3 (12.5%, p < 0.0001) of the 24 corresponding patients in the r-CHC group. Of
Aim: To study the hepatic histopathological features in genotype 4 chronic HCV and their relation to demographic, clinical and laboratory features. Methods: This study included 200 patients with serologic and virologic diagnosis of chronic HCV. HCV genotyping was performed. Percutanious liver biopsy was performed to all patients. Scoring system of Ishak et al., 1995 was applied for assessment of fibrosis stage and necroinflammatory injury with iron staining. The relation between histological features and demographic, clinical, and laboratory features was studied. Results: Two hundred patients with mean age 39.5± 8.7 years, range 20-58, 158 (79%) male were included. Liver biopsy examination showed that only 28 (14%) had cirrhosis. Most of our patients (125; 62.5%) revealed no or only portal tract expansion by fibrosis. Stage of fibrosis is significantly correlated with ALT, AST, platelet count and direct bilirubin. For necroinflammatory injury, most of our patients (130; 65%) had mild activity, and only 4 patients had marked activity. Degree of inflammatory activity is correlated with ALT level. Steatosis was found in 52% of our patients with marked degree in only 8 patients (4%). Four biopsy specimens were found positive for schistosomiasis. Hemosedrosis was detected in 15% of the examined specimens, most of them of mild type. Conclusions: (1) Chronic HCV genotype 4 has a lower possibility of cirrhosis at presentation and lower incidence of hemosedrosis than other genotypes. (2) Steatosis associating genotype 4, may be similar to that of genotype 1 rather than genotype 3. (3) No significant effect of schistosomal infection on histopathological changes. (4) ALT is significantly correlated with degree of inflammatory activity and stage of fibrosis, however, AST, platelet count, and bilirubin level are correlated with stage of fibrosis. ~
Anti-HCV profile in serum specimens from HCV infected patients coinfected with opportunistic diseases
G.B. Bochkova*, D.A. Polushina, L.V. Kulikova, S.N. Fomina, A.N. Burkov, A.R Obriadina, ]11. Ulanova. Scientific, RPC
Diagnostic systems, Nizhny Novgorod, Russian Federation Background and Objectives: One of the problems of EIA diagnostic hepatitis C infection (HCV) is associated with the reliable verification screening assays results. Serum samples from HCV infected patients with coinfections may present with atypical results in serological tests. The purpose of the present study was to evaluate the antibody profile of serum specimens from HCV infected patients coinfected with opportunistic diseases. Methods: The correlation of anti-HCV antibody profile with presence antibodies to TORCH infections in sera from coinfected patients has been investigated. Well defined anti-HCV positive serum samples (n = 162) were additionally tested on presence of anti-lgG, IgM, IgA to Toxoplasma gondii and Chlamydia trachomatis; anti-lgG to HSV-1 and HSV-2, anti-lgG, IgM to CMV and anti-VCA IgG, antiVCA IgM, anti-EA, anti-EBNA. As a control group, anti-HCV negative serum samples from healthy blood donors have been used (n = 247). All data were statistically processed. Results: It has been shown that anti-Toxo IgG in the anti-HCV positive serums meet twice less often than in serums of healthy donors (p >0.995). Besides this in serum samples with antibodies to all HCV proteins or with antibodies to three HCV proteins (core, NS3 and NS4) the lower concentration anti-lgG to HSV-1 and HSV-2 is observed (p>0.966). Moreover, it has been revealed that in specimens containing antibodies to the structural protein of HCV as a unique marker of infection or in a combination with antibodies to nonstructural HCV proteins the twice lower concentration of antibodies to a capside antigen (VCA) of the Epstein-Barr (EB) virus is observed (p>0.95). In specimens containing antibodies to the core protein of HCV in a combination with NS4 HCV the concentration of antibodies to the NA antigen of EB virus was one and a half time more than in samples from the control group (p > 0.902). Anti-NS3 is a unique marker of the HCV infection presented in 45% of anti-lgA and 31% of anti-lgG Chlamydia trachomatis positive sera. The combination of anti-NS3 with anti-core or combination of anti-nonstructural HCV proteins only were observed in 55% of
$107 anti-lgA and 69% of anti-lgG Chlamydia trachomatis positive sera (p > 0.995). Other statistically significant correlations have not been revealed. Conclusion: There is bidirectional influence of the hepatitis C virus and opportunistic infections. Serum specimens from HCV patients coinfected with TORCH infections very often have no complete HCV-antibody spectrum.
IP•
Hepatitis C prevalence with normal serum alanine aminotransferase in a cohort analytical study of population referred to Iranian Red Crescent clinic in Azerbaijan Republic
N. Farhadi 1, M. Najafizadeh 2 *, Z. Karayev3. 1Physiology, Yasouj
University of Medical Sciences, Yasouj, Iran, 2Immunology and allergy, 3Microbiology and Immunology, Azerbaijan Medical University, Baku, Azerbaijan Background and Objectives: It is estimated that about 3.0% of the world's population have HCV. In 1998, the estimated annual costs of acute and chronic hepatitis C was above US$1 billion in the USA. A clear distinction among the different types of viral hepatitis cannot be made solely on the basis of epidemiological features and also ALT levels in hepatitis C according to recent research results. This study is aimed to determine of prevalency of hepatitis C and serum ALT normalization in patients. Methods: in this analytical descriptive study 1908 (44.3% M, 55.7% F) persons 11 to 93 years of age (M=43.33, SD=14.07) were selected by sequential sampling method according to ,Y,=5%, 15= 20%. Samples were from various regions of Azerbaijan Republic. Hepatitis C Virus infection was confirmed by two times positive AntiHCV test. Serum ALT titration was performed for 44 patients with positive test. Data were analysed by Student's T-test (one-sample, independent) and ~2 tests with SPSS 11.5 software. Results: Prevalence of hepatitis C in this study was 3.9% (male: 4.0%,female: 3.8%), significantly different from the world mean. ALT level was normal in 47.7% (male: 60.0%, female: 37.5%) of patients with hepatitis C. There was no statistically significant difference between gender and age group in results (p >0.05). Conclusion: We conclude that prevalence of hepatitis C in a part of Azerbaijan Republic population (3.9%) is 0.9% greater than world mean (3.0%). In over 40% of cases the risk factor(s) cannot be identified. In other cases they may be due to many reasons of contact with contaminated blood, especially blood products, hemodialysis, hemophiliacs, injecting drug and unsterile medical or dental equipment. Also we suggest that patients with hepatitis C virus infection may have normal ALT levels thus histopathology grade and stage of liver damage is not reflected by serum ALT levels. [ - ~ - ~ 1 Anti-HCV IgG avidity index in acute hepatitis C N. Coppola 1, R. Pisapia 1, S. Martini 1, C. Marrocco 1, L. Vatiero 1, V. Messina 2, G. Tonziello2, C. Sagnelli 1, R Filippini 1, E Piccinino 1, E. Sagnelli 1 *. 1Public Medicine, Second University of Naples,
Naples; 2Infectious Diseases, San Sebastian Hospital, Caserta, /ta/y Background and Objectives: In this study we evaluated the usefulness of detecting the anti-HCV IgG Avidity Index (HCV AI) to distinguish AHC from r-CHC by investigating 40 consecutive patients with AHC and 37 consecutive patients with r-CHC. Methods: We enrolled 40 consecutive patients with AHC documented by seroconversion to anti-HCV and 37 consecutive patients with r-CHC. Forty patients with chronic hepatitis C (CHC) were also investigated. The HCV AI was determined by an ELISA on patients'sera 1:10 pre-diluted with 1 M guanidine. Results: On admission the HCV AI values were significantly lower in the AHC group (mean±SD: 0.50±0.30) than in the r-CHC group (0.94±0.25, p < 0.0001) and the CHC group (1.06±0.20, p < 0.0001), but no cut-off value distinguished AHC from r-CHC. An increase in HCV AI of at least 20% during the acute phase of the illness, considered sign of acute HCV infection, was observed in 24 (72.7%) of the 33 patients in the AHC group having a follow-up and in 3 (12.5%, p < 0.0001) of the 24 corresponding patients in the r-CHC group. Of