Brief Article
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World J Gastroenterol. May 7, 2013; 19(17): 2691-2696
Published online May 7, 2013. doi: 10.3748/wjg.v19.i17.2691
Coinfection with hepatitis C virus and schistosomiasis: Fibrosis and treatment response
Mahasen Abdel-Rahman, Mohammad El-Sayed, Maissa El Raziky, Aisha Elsharkawy, Wafaa El-Akel, Hossam Ghoneim, Hany Khattab, Gamal Esmat
Mahasen Abdel-Rahman, Mohammad El-Sayed, Maissa El Raziky, Aisha Elsharkawy, Wafaa El-Akel, Gamal Esmat, Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Hossam Ghoneim, Department of Endemic Medicine and Hepatology, Faculty of Medicine, Beni-Suef University, Beni-Suef 12396, Egypt
Hany Khattab, Department of Pathology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Author contributions: Abdel-Rahman M, El Raziky M and Esmat G designed the research and revised the manuscript; El-Sayed M, Elsharkawy A and Ghoneim H performed the research, collected the data and wrote the manuscript; Khattab H performed the histopathological analysis; Elsharkawy A and El-Akel W analyzed the data and interpreted the results.
Supported by The Science and Technology Development Fund, No. 1708
Correspondence to: Dr. Mohammad El-Sayed, Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt. mohammadelsayed76@yahoo.com
Telephone: +20-2-35827132 Fax: +20-2-25326543
Received: October 31, 2012
Revised: January 29, 2013
Accepted: February 5, 2013
Published online: May 7, 2013
Processing time: 188 Days and 5.6 Hours
Abstract

AIM: To assess whether schistosomiasis coinfection with chronic hepatitis C virus (HCV) influences hepatic fibrosis and pegylated-interferon/ribavirin (PEG-IFN/RIB) therapy response.

METHODS: This study was designed as a retrospective analysis of 3596 chronic HCV patients enrolled in the Egyptian National Program for HCV treatment with PEG-IFN/RIB. All patients underwent liver biopsy and anti-schistosomal antibodies testing prior to HCV treatment. The serology results were used to categorize the patients into group A (positive schistosomal serology) or group B (negative schistosomal serology). Patients in group A were given oral antischistosomal treatment (praziquantel, single dose) at four weeks prior to PEG-IFN/RIB. All patients received a 48-wk course of PEG-IFN (PEG-IFNα2a or PEG-IFNα2b)/RIB therapy. Clinical and laboratory follow-up examinations were carried out for 24 wk after cessation of therapy (to week 72). Correlations of positive schistosomal serology with fibrosis and treatment response were assessed by multiple regression analysis.

RESULTS: Schistosomal antibody was positive in 27.3% of patients (15.9% females and 84.1% males). The patients in group A were older (P = 0.008) and had a higher proportion of males (P = 0.002) than the patients in group B. There was no significant association between fibrosis stage and positive schistosomal serology (P = 0.703). Early virological response was achieved in significantly more patients in group B than in group A (89.4% vs 86.5%, P = 0.015). However, significantly more patients in group A experienced breakthrough at week 24 than patients in group B (36.3% vs 32.3%, P = 0.024). End of treatment response was achieved in more patients in group B than in group A (62.0% vs 59.1%) but the difference did not reach statistical significance (P = 0.108). Sustained virological response occurred in significantly more patients in group B than in group A (37.6% vs 27.7%, P = 0.000). Multivariate logistic regression analysis of patient data at treatment weeks 48 and 72 showed that positive schistosomal serology was associated with failure of response to treatment at week 48 (OR = 1.3, P = 0.02) and at week 72 (OR = 1.7, P < 0.01).

CONCLUSION: Positive schistosomal serology has no effect on fibrosis staging but is significantly associated with failure of response to HCV treatment despite antischistosomal therapy.

Keywords: Hepatitis C virus; Schistosomiasis; Coinfection; Fibrosis; Treatment response

Core tip: Both hepatitis C virus (HCV) and schistosomiasis are highly endemic in Egypt and coinfection is frequently encountered. The effect of such coinfection on hepatic fibrosis and response to pegylated-interferon and ribavirin therapy (PEG-IFN/RIB) remains unclear. Our study aimed to assess the impact of schistosomiasis on hepatic fibrosis and response to PEG-IFN/RIB therapy in chronic HCV Egyptian patients. Antischistosomal antibody was positive in 27.3% of 3596 chronic HCV patients. Findings suggest positive schistosomal serology has no effect on fibrosis stage but is significantly associated with failure of response to HCV treatment despite antischistosomal therapy.