Detection of occult hepatitis C virus infection among Egyptian patients with hepatocellular carcinoma who achieved sustained virologic response to direct-acting antiviral therapy

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Kassem F.E.M.A.; El-Kholy E.E.; Mohamed A.H.; Abdul-Mohaymen A.M.; Gomaa A.I.; Hassan A.S.M.

Journal: Egyptian Pharmaceutical Journal

Publisher: National Information and Documentation Center (NIDOC) Academy of Scientific Research and Technology

Publication Date: 1 April 2025

Volume / Issue: Volume 24 / Issue 2

Pages: 171–180

ISSN: 16874315

DOI: 10.21608/epj.2025.407585

Scopus: View on Scopus

Document Type: Article

Access: All Open Access; Hybrid Gold Open Access

Authors and Affiliations

Kassem F.E.M.A., Department of Electron Microscopy, Theodore Bilharz Research Institute, Giza, Egypt; El-Kholy E.E., Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; Mohamed A.H., Department of Electron Microscopy, Theodore Bilharz Research Institute, Giza, Egypt; Abdul-Mohaymen A.M., Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; Gomaa A.I., Department of Tropical Medicine, National Liver Institute, Menoufia University, Menoufia, Egypt; Hassan A.S.M., Department of Electron Microscopy, Theodore Bilharz Research Institute, Giza, Egypt

Abstract

Background Occult hepatitis C virus infection (OCI) is defined as the presence of hepatitis C virus (HCV) RNA in nonserum reservoirs without any detectable HCV-RNA in serum by standard assays. The association between OCI and hepatocellular carcinoma (HCC) is controversial. Direct-acting antiviral (DAA) therapy effectively controls HCV infection and proves sustained virological response (SVR). However, HCC after DAA therapy is debatable. Objective In this study, we tried to detect OCI in HCC Egyptian patients who achieved SVR post-DAA therapy for possible correlation and prediction for HCC. Patients and methods A cross–sectional study included seventy HCC Egyptian patients who achieved SVR post sofosbuvir/daclatasvir (SOF/DACLA) +/–ribavirin therapy. HCV-RNA was detected in peripheral blood mononuclear cells (PBMCs) by RT-PCR. Immune transmission electron microscopy (TEM) was done to study OCI in PBMCs using specific anti-HCV antibodies. Results and conclusion TEM examination revealed positive OCI in PBMCs of all patients (70/70) with 3 stages of grading reflecting viral particle load in PBMCs, with 68.6% of the patients having a marked OCI grade, while PCR only detected 5.7% (4/70) of OCI. Nearly 67.1% of the cases received dual anti-HCV therapy (sofosbuvir/daclatasvir). Ribavirin-inclusive DAA treatment shows a higher grade of OCI (P=0.02). The average duration from SVR to HCC development was 29.8±13.4 months. In conclusion, DAA drugs effectively eliminate HCV in serum, but OCI is still considered a risk for developing HCC, recommending a re-definition for SVR through detecting HCV-RNA in serum, PBMCs, and TEM studies. Our study is the first to provide electron microscopy as a sensitive tool for OCI detection with established superiority over the PCR technique. © 2025 Egyptian Pharmaceutical Journal | Published by NIDOC.

Keywords

direct acting antiviral drugs; hepatocellular carcinoma; immune electron microscopy; occult hepatitis C infection; daclatasvir plus sofosbuvir; ribavirin; virus antibody; virus RNA; adult; antiviral therapy; Article; cancer patient; controlled study; correlation analysis; cross-sectional study; Egyptian; female; hepatitis C; Hepatitis C virus; Hepatitis C virus genotype 4; human; human cell; liver carcinogenesis; liver cell carcinoma; major clinical study; male; nonhuman; peripheral blood mononuclear cell; prediction; real time polymerase chain reaction; sustained virologic response; transmission electron microscopy; virus detection; virus load; virus particle

Citation Information

Scopus Citations: 0

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