Salah Agha

Exponential Spread of Hepatitis C Virus Genotype 4a in Egypt

Hepatitis C virus (HCV) infects >10% of the general population in Egypt, in which intravenous injection with an antimony compound for endemic schistosomiasis in the past has been implicated. To simulate the epidemic history of HCV in Egypt, sera were obtained from 3608 blood donors at 13 governorates in or surrounding the Nile valley during 1999. The prevalence of antibody to HCV (anti-HCV) and genotypes was determined in them, and the molecular evolutionary analysis based on the neutral theory was applied to HCV isolates of genotype 4a, which is outstandingly prevalent in Egypt and indigenous there. Of 3608 sera, 317 (8.8%) were positive for anti-HCV. The molecular evolutionary analysis on 47 HCV genotype 4a isolates of carriers from various districts in Egypt indicated that the spread of HCV-4a would have increased exponentially during the 1940s through 1980 when oral medications became available. In conclusion, the estimated spread time is consistent with the duration of intravenous antimony campaigns in Egypt.

Prevalence of Low Positive Anti-HCV Antibodies in Blood Donors: Schistosoma mansoni Co-Infection and Possible Role of Autoantibodies

Patients infected with schistosoma frequently show a high seroprevalence of anti‐hepatitis C virus (anti‐HCV) antibodies. The aim of this study was to find the underlying reason for this phenomenon, and to examine a possible involvement of autoantibodies. Out of 2,400 Egyptian blood donors, 192 (8%) were anti‐HCV positive by ELISA. They were 133 males and 59 females with age ranging from 27 to 48 years. According to optical density ratio (ODR) of anti‐HCV antibodies, 96 cases were low positive (LP) with ODR (1–2) designated as group I, and 96 were high positive (HP) with ODR (≥2) (group II). Both groups were examined for quantitative HCV core antigen (HCVcAg), liver function (Albumin, ALT, AST) and anti‐Schistosoma mansoni (anti‐Sm) IgG. Group I cases were HCVcAg negative with normal liver function tests, and 44 of them were anti‐Sm positive. Ninety cases (93.75%) of group II were HCVcAg positive with markedly affected liver function tests and 72 cases were anti‐Sm positive. All group I cases were examined for autoimmune markers (ANA, AMA, SMA and LKM). In group I, 33 (75%) of anti‐Sm positive cases were positive for one or more of the autoimmune markers examined, while none of anti‐Sm negative was positive for any marker with significant difference between the two groups (P<0.0001). Our results primarily on blood donors indicate that LP anti‐HCV frequently represents false‐positive reactivity with a possible role of Sm‐induced autoantibodies in this phenomenon.

Correlation of serum hepatitis C virus RNA titre with aminotransferases and liver histopathological findings in HCV-seropositive cases with end-stage chronic liver disease.

The quantity of circulating hepatitis C virus (HCV) RNA, aminotransferases and the degree of liver cell injury in relation to HCV serotype have not been fully studied. In this work, we estimated the HCV RNA titre in serum and correlated the findings with levels of aminotransferases, gamma glutamyltransferase (GGT), and liver histopathological changes and with HCV serotype. HCV RNA was found in 22 out of 30 HCV-seropositive cases included in this study (73. 3%) and serotype 4 represented 90.9% (20/22). Levels of aminotransferases and GGT correlated with the levels of serum HCV RNA. Noticeably, GGT showed the highest positive correlation with the level of HCV RNA. Liver histopathological findings of 15 patients showed that eight had hepatocellular carcinoma and seven had cirrhosis. There was no significant difference between these two groups regarding levels of enzymes or serum HCV RNA titre.

Early detection of active Human Cytomegalovirus infection after living-donor liver transplantation

Human cytomegalovirus (HCMV) is a member of the beta herpes virinae. It is one of the most important virus in transplantation. It has direct and indirect impact on liver transplant recipient outcome. We aimed to diagnose early active HCMV infection in living donor liver transplant (LDLT) recipients. Also, to correlate the associated clinical and laboratory findings with HCMV infection. Here, we investigate 76 LDLT recipients for early detection of active HCMV infection in a period of 1-6 months after liver transplantation upon their suggested clinical data. These samples were collected in the period from 4/2013 to 12/ 2015 at Gastroenterology center, Mansoura University. They were 68 males and 8 females. HCMV infection diagnosed by ELISA (Ig M, Ig G) and real time PCR. Seventy-four patients were IgG seropositive recipient. Three patients (3.9%) were positive IgM. Ten samples from 76 patients (13.2%) were positive by real-time polymerase chain reaction (PCR). In this study, we concluded that, LDLT recipients are at high risk of HCMV infection (13.2%) and the most suitable method for HCMV detection was PCR.