BASELINE LIVER HISTOPATHOLOGY AS A PREDICTOROF SUSTAINED VIROLOGICAL RESPONSE TO PEGYLATED INTERFERON AND RIBAVIRIN THERAPY IN CHRONIC HEPATITIS C PATIENTS

Abstract

HCV is a worldwide disease with an estimated prevalence by WHO of 3%. Hepatitis C virus 4 is prevalent in Africa and the Middle East, especially Egypt. The treatment of HCV4 is affected by many factors, related to the virus itself (genotype, pretreatment viral load and prevalent quasispecies), to the host (genetic factors, age, ethnicity and liver histology), to the presence of comorbidities (obesity, insulin resistance and co-infections) and to the therapeutic drugs (type, dose and duration). Optimizing treatment is the goal of daily practice to obtain the best results for the patient (Esmat et al., 2013). Egypt has the highest seroprevalence for HCV. There is a hypothesis that the prevalence is linked to( a now discontinued) mass treatment campaign for schistosomiasis, which is endemic in that country (Mohamed et al., 2005). Regardless of how the epidemic started, a high rate of HCV transmission continues in Egypt (Mohamed et al., 2005). Factors identified to favor good response rates are lower age of patients, shorter duration of disease, low histological activity index, low levels of hepatitis C virus RNA and virus sub type 1 b (Orito, et al; 1994).However, several patients fail to achieve sustained virologic response despite favorable pretreatment factors, these patients are thus subjected to a morbid and expensive treatment without any long term benefit thus, there is a pressing need for a better understanding the role played by different actors that might be implicated in treatment outcome. So, as treatment of HCV infection has evolved, additional outcomes have gained importance, such as histopathological response (improvement of necroinflammation and fibrosis in liver biopsy ) and health related quality of life (Shiffman, et al; 2001).