Prevalence of Hepatitis C Viral Infection in Egyptian Children with type 1 Diabetes Mellitus

Abstract

SUMMARY L iver disease among patients with type 1 diabetes mellitus (T1DM) may be attributed to diverse pathologies; fatty liver, hepatic glycogenosis, hepatitis C virus (HCV) infection or autoimmune hepatitis (AIH). The pediatric literature about type 1 diabetes related liver disease is scant and mostly limited to small case series or case reports for children presenting with symptomatic hepatic dysfunction during time of metabolic decompensation and ketosis. Hepatitis C and DM represents a two-way association. Particular risk factors include using shared spring-triggered finger-stick device for glucose self-monitoring or use of multi-dose insulin vials. FibroScan, or transient elastography (TE), non-invasively assesses liver fibrosis and presents comparable performance to liver biopsy to predict liver-related outcomes in patients with chronic liver diseases. The aim of this study was to determine the prevalence of HCV infection in children and adolescents with T1DM and possible risk factors, to determine the effect of HCV on glycemic control and its affection on liver and the degree of liver fibrosis by TE. This cross sectional study was carried out on 100 type 1 diabetic patients; 39 males and 61 females. The mean age of patients was 13.8 ±1.9 years (range, 11-18 years) and their mean disease duration was 6.5 ± 1.7 years. None of the studied patients had micro- or macro-vascular complications. All the included patients were subjected to detailed medical history and thorough clinical examination. Laboratory investigations included mean fasting blood glucose (FBG) in the last 3 months prior to the study, liver function tests, fasting lipid profile, HbA1c and coagulation profile. HCV antibodies were tested by enzyme linked immunosorbent assay and patients with an anti-HCV antibody-positive sample were further confirmed by testing HCV-RNA in their sera using quantitative real-time reverse-transcription-polymerase chain reaction. Serum immunoglobulins were assessed and autoimmune antibodies were detected using indirect immunofluorescence methods. Pelvi-abdominal ultrasound was performed for all patients and TE was indicated for patients with elevated alanine transferase (ALT), HCV infection, positive AIH antibody and/ or abnormal ultrasound findings. A hyperechogenic liver and/or hepatomegaly on ultrasound were attributed most likely to excess glycogen or fat in the liver, after negative extensive work-up to rule out other underlying liver disease. Liver biopsy was done when indicated and when parental consent was obtained. In this study, thirty-one (31%) patients were found to have one or more abnormalities; - Clinical hepatomegaly in 8% (2 had AIH, 1 had HCV, 1 had Mauriac syndrome, 2 had NAFLD and 2 had NASH). - Elevated ALT in 10% (4 had AIH, 3 had HCV, 1 had Mauriac syndrome, 2 had NASH). - Autoimmune antibodies in 11%. - HCV in 6 %. The incidence of HCV infection by ELISA was 7% and as confirmed by PCR was 6% among the studied type 1 diabetic patients. - Abnormal hepatic ultrasound in 20% (5 had AIH, 2 had HCV, 1 had Mauriac syndrome, 9 had NAFLD and 3 had NASH).