Coinfection with hepatitis C virus and schistosomiasis: Fibrosis and treatment response

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

HCV: Hepatitis C virus; PCR: Polymerase chain reaction; PEG-IFN: Pegylated-interferon; RIB: Ribavirin.

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

Cited from reference 10. A: Activity; F: Fibrosis.

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

Data are expressed as mean ± SD. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; HCV: Hepatitis C virus; BMI: Body mass index.

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

EVR: Early virologic response; ETR: End of treatment response.

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

IFN: Interferon; BMI: Body mass index.