Abdel-Rahman M, El-Sayed M, El Raziky M, Elsharkawy A, El-Akel W, Ghoneim H, Khattab H, Esmat G. Coinfection with hepatitis C virus and schistosomiasis: Fibrosis and treatment response. World J Gastroenterol 2013; 19(17): 2691-2696 [PMID: 23674877 DOI: 10.3748/wjg.v19.i17.2691]
Corresponding Author of This Article
Dr. Mohammad El-Sayed, Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt. mohammadelsayed76@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Brief Article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 7, 2013; 19(17): 2691-2696 Published online May 7, 2013. doi: 10.3748/wjg.v19.i17.2691
Table 1 Inclusion criteria and exclusion criteria
Inclusion criteria
Age ≥ 18 yr and ≤ 60 yr
Positive HCV antibodies and detectable HCV RNA by PCR
Positive liver biopsy for chronic hepatitis with F1 METAVIR score and elevated liver enzymes or F2/F3 METAVIR score
Naïve to treatment with PEG-IFN and RIB
Hepatitis B surface antigen negativity
Normal complete blood count, normal thyroid function, prothrombin concentration ≥ 60%, normal bilirubin, α-fetoprotein < 100 (ng/mL) and antinuclear antibody titer < 1/160
Exclusion criteria
Serious co-morbid conditions such as severe arterial hypertension, heart failure, significant coronary heart disease, poorly controlled diabetes (hemoglobin A1C > 8.5%), chronic obstructive pulmonary disease
Major uncontrolled depressive illness
Solid transplant organ (renal, heart, or lung)
Untreated thyroid disease
History of previous anti-HCV therapy
Body mass index (BMI) > 35 kg/m²
Known human immunodeficiency virus (HIV) coinfection
Hypersensitivity to one of the two drugs (PEG-IFN, RIB)
Concomitant liver disease other than hepatitis C (chronic hepatitis B, autoimmune hepatitis, alcoholic liver disease, hemochromatosis, α-1 antitrypsin deficiency, Wilson’s disease)
Liver biopsy showing severe steatosis (> 66%) and steatohepatitis, decompensated cirrhosis, hepatocellular carcinoma or METAVIR score F4
Table 2 Necroinflammatory activity and fibrosis staging scale
Feature
Grade A0
No histologic necroinflammatory activity
Grade A1
Mild activity
Grade A2
Moderate activity
Grade A3
Severe activity
Stage F0
No fibrosis
Stage F1
Portal fibrosis without septa
Stage F2
Portal fibrosis with rare septa
Stage F3
Numerous septa without cirrhosis
Stage F4
Cirrhosis
Table 3 Baseline characteristics
Schisto + ve (n = 983)
Schisto - ve (n = 2613)
P value
Age
42.59 ± 9.21
41.62 ± 9.81
0.008
Albumin (ref.: 3.5-5.5 mg/dL)
4.20 ± 0.47
4.20 ± 0.47
0.251
AST (ref.: 40 IU/L)
55.91 ± 33.91
57.07 ± 46.00
0.412
ALT (ref.: 40 IU/L)
63.19 ± 41.68
63.38 ± 43.30
0.908
HCV RNA, IU/mL
1.4 × 106± 6.9 × 106
9.5 × 105± 7 × 106
0.083
BMI
28.12 ± 4.09
28.27 ± 4.4
0.387
Male/female
5.3/1
3.88/1
0.002
Table 4 Virological response at weeks 12, 24, 48 in relation to schistosomal serology n (%)
Anti-schisto antibody
P value
Negative
Positive
Total
(n = 2613)
(n = 983)
(n = 3596)
Responders at week 12 (EVR)
2335 (89.4)
850 (86.5)
3185 (88.6)
0.015
Responders at week 24
1768 (67.7)
626 (63.7)
2394 (66.6)
0.024
Responders at week 48 (ETR)
1621 (62.0)
581 (59.1)
2202 (61.2)
0.108
Table 5 Multivariate logistic regression analysis in which the failure of treatment is the dependent variable at weeks 48 and 72
Factors
OR
P value
95%CI
Lower
Upper
Week 48
Age of > 50 yr
1.15
0.245
0.91
1.50
Female
0.65
0.000
0.51
0.80
Viremia, > 600 × 103 IU/mL
1.78
0.000
1.41
2.30
IFNα2b
1.21
0.050
1.01
1.50
Activity, A2, A3
0.68
0.001
0.54
0.90
Fibrosis, > F2
1.69
0.000
1.35
2.10
BMI, > 30 kg/m2
0.86
0.009
0.76
0.96
Positive schisto status
1.29
0.015
1.10
1.60
Week 72
Age of > 50 yr
1.0
0.990
0.7
1.3
Female
0.7
0.006
0.5
0.9
Viremia, > 600 × 103 IU/mL
1.6
0.001
1.2
2.2
Activity, A2, A3
0.5
< 0.01
0.4
0.7
Fibrosis, > F2
1.9
< 0.01
1.5
2.5
Positive schisto status
1.7
< 0.01
1.3
2.1
Citation: Abdel-Rahman M, El-Sayed M, El Raziky M, Elsharkawy A, El-Akel W, Ghoneim H, Khattab H, Esmat G. Coinfection with hepatitis C virus and schistosomiasis: Fibrosis and treatment response. World J Gastroenterol 2013; 19(17): 2691-2696