Liver is considered the target of hepatitis C virus (HCV), which has marked tropism for hepatocytes. In this study, we investigated changes in bone marrow (BM) and blood and their correlation with viremia level in 30 pale patients with chronic HCV who were selected before antiviral therapy. Patients with BM positive for HCV RNA (53.33 %) showed moderate to high viremia, while patients with BM negative for RNA (46.67 %) had low viremia. There was no significant difference in the liver histopathology between patients with HCV-RNA-negative and positive BM. Patients with BM positive for HCV RNA showed significant changes in BM cells, including the degree of immune complex deposition and alterations in peripheral blood counts compared to patients with BM negative for RNA and healthy controls, suggesting that BM changes could be a sequel or a reservoir for HCV viremia.

The rate of hepatocellular carcinoma (HCC) is increasing worldwide including Egypt. Non-B non-C HCC was reported in some countries. We aimed to investigate P53 antibodies and alpha-fetoprotein in patients with non-B non-C HCC in our region. In a case series study, included 281 patients with HCC and 20 patients with liver cirrhosis of matched age, sex and social factors were received for management at Tanta University Hospitals. Sera were tested for HCV and HBV markers by ELISA/PCR, alpha-fetoprotein (AFP) level and anti-p53 antibody were evaluated by ELISA. Antinuclear antibody, serum copper and iron were assessed in non-viral HCC. Liver scanning and biopsy were evaluated. Non-B non-C HCC patients were 13.87% of total. P53 antibody serum level in non-B non-C HCC patients showed insignificant difference (p>0.05) as compared to viral-associated HCC, while significant as compared to cirrhosis. They had significant decrease in serum AFP level (p<0.001) as compared to viral-associated HCC. Their tumors were mainly solitary, and have smaller-sizes. Sensitivity, specificity, PPV, NPV and accuracy test of anti P53 antibody positive patients were 91.52%, 84.63%, 90.34%, 80.2% and 74.8% respectively. It correlates positively with AFP, tumor size and staging, MELD score and Child-Pugh score.Non-B non-C HCC showed high serum prevalence of anti-p53 as viral-associated HCC suggesting an evidence of high onchogenecity. It appears of much benefit in diagnosis, follow up and differentiation from cirrhosis in presence of low levels of alpha-fetoprotein.

Pesticides and smoking heavy exposure can be considered as primary risks for non-B non-C HCC. Phosphate and ammonium sulfate fertilizers were associations. The study will increase awareness for better prevention and management.

Hepatitis C and brucellosis are infectious diseases that occur worldwide, and both are endemic in Egypt. Co-infection with both agents is possible, and this can involve the liver in various ways. In this study, we investigated serum tissue inhibitor metalloproteinase-1 (TIMP-1), viral load, and liver functions in patients co-infected with hepatitis C virus (HCV) before and after brucellosis treatment. Over 3 years, 241 consecutive HCV patients (before interferon therapy was received) with recurrent fever who had occupational contact with animals were tested for brucellosis co-infection by a standard tube agglutination test. In patients with dual infection, viraemia (RT-PCR), TIMP-1 measured by ELISA, and liver functions were assessed and re-evaluated 2 months after brucellosis treatment. The number of patients with HCV/brucellosis co-infection was 32 out of 241 (13.3%). TIMP-1, viraemia, AST, ALT and bilirubin showed significant decrease (improvement) after brucellosis treatment (p < 0.001) but an insignificant difference (p > 0.05) with regard to serum albumin and prothrombin concentration. The study revealed that brucellosis is an important infection in HCV-infected patients and can aggravate the course of disease, suggesting that early treatment and prevention are important.

Background and study aim: Chronic HCV can progress to cirrhosis, and HCC. Liver biopsy is the best to assess and monitor progression. But it has limitations.The aim of this study was to evaluate noninvasive indicators of fibrogenesis, matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase-1 (T1MP1) and AST/Platelet (APRI-score) for assessment of early hepatic histopathology in chronic-HCV, and cirrhosis. Patients and methods: A cross section study included 344 participants from Tanta University Hospitals, (GI): 129 asymptomatic chronic-HCV, (GII): 135 with symptoms. (GIII): 80 patients with compensated HCV-related cirrhosis and 30 healthy controls. Investigations proved diagnosis, and excluded associated diseases. APRI-Score was evaluated. Quantitative immunoassay measured serum MMP-2 and TIMP-1, guided liver biopsy for histopathology staging and grading. Results: Serum MMP-2& TIMP-1 showed significant difference between control& GI, GII, GIII, and GI, GII& GIII (P< 0.001) with significant correlation between GI& GIII, between GII & GIII, while insignificant between G1 & GII. There was significant positive correlation between APRI-score versus Metavir A, Metavir F, Ishak score of fibrosis, serum MMP-2 and serum TIMP-1 (P <0.001). Combined serum MMP-2, TIMP-1 and APRI-score showed high sensitivity, and specificity. Conclusion: This combination of markers raised the sensitivity, specificity and correlations. It could reflect early hepatic histopathology, developing cirrhosis and potentially could replace liver biopsies in pre-treatment, follow up of chronic-HCV, and screening of asymptomatic patients.