20 May 2003 : Case report
Med Sci Monit 2003; 9(2): 16- :: ID: 15274
Background:Patients with haemophilia were infected with HCV through blood before the year 1993 when in Poland screening tests for anti-HCV of blood donors were introduced.Chronic hepatitis C is a major clinical problem in these patients,with hepatic failure and cirrhosis of the liver being one of the main complications and common cause of death.Our findings indicate,however, that chronic hepatitis are not observed in all HCV infected patients.The aim of the study was the analysis of the incidence of anti-HCV as well as the dependence of the occurrence of chronic hepatitis and cirrhosis of the liver on the HCV RNA detection and the genotype of the virus.Simultaneously, patients were analysed for the HBsAg and HBVDNA detection.Material/Methods:The study comprised 35 consecutive patients with haemophilia (30 with the severe form of haemophilia A and 5 with haemophilia B),mean age 42.9 years (16 –65 years),treated in the Department of Surgery for different indications between October 2002 and January 2003. Previously,the patients had been treated with different concentrates of clotting factors,including lyophilizing factors. In all patients,anti-HIV1/2,anti-HCV and HBsAg tests were carried out using commercial immunoenzymatic tests.HCV RNA was investigated by Cobas Amplicor HCV v.2.0 test (Roche Diag)while HCV genotype by InniLipa HCV (Innogenetic).In 23 patients,the HBV DNA was analysed using Real Time PCR (acc to Aki et al,1999).In all patients activity of asparaginian aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltranspeptidase (GTP) as well as the concentration of bilirubin,albumin and the prothrombin time were measured.Results: HCV antibodies were detected in all 35 patients (100%)and HCV RNA in 28 of them (80%).Genotype 1a was found in 1 patient,genotype 1b in 20 and genotype 3a in 7 patients.Elevated ALT activity,indicating chronic hepatitis was observed in 21 out of 35 patients (60%):in 1/7 patients (14%) without HCV RNA and in 20/28 patients (71%)with HCV RNA virus.Elevated ALT activity concerned 15 out of 20 patients (75%)with genotype 1b,1 with genotype 1a and 5 out of 7 patients with genotype 3a.Evidence of cirrhosis of the liver was detected in 9 patients:8 with genotype 1b and 1 with genotype 1a.In 5 patients this diagnosis was based on the portal hypertension syndrome with the presence of esophageal varices,in 1 patient cirrhosis was diagnosed intraoperatively while the remaining 3 patients presented hepatomegaly and biochemical features of cirrhosis of the liver.HBsAg was detected in 4/35 patients.HBV DNA was not observed in any of the patients,including those with HBsAg. Conclusions:1.The frequency of chronic hepatitis is higher among patients with detected HCV RNA than in patients with no HCV RNA.2.the incidence of elevated ALT was not found to be dependent on the HCV genotype.3.All patients with cirrhosis of the liver were infected with genotype 1.
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