Correlation Between Serum Neopterin And Response To Treatment of chronic Hepatitis C Virus Infection

Abstract

Summary H epatitis C virus (HCV) infects up to 180 million people worldwide and is a major cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma. The current treatment, based on the combination of peginterferon a (pegINF-a) and ribavirin, leads to a sustained virological response (SVR) in about 40–50% of patients with the HCV genotype 1 or 4 and in about 80% of those with the genotype 2 or 3. The aim of this study was to assess serum neopterin concentrations as a marker of virological response to antiviral therapy by peginterferon a combined with ribavirin in Egyptian patients with hepatitis C (genotype 4). Neopterin is a pteridine derivative produced by monocytes and macrophages under the control of gamma-interferon and released from T-cells by the activation of the cellular immune system. Neopterin serum level above 10 nmol/L is regarded as elevated. 60 cases were included in this study. Cases were divided into three groups:  Group I: 20 patients with early virological response  Group II: 20 patients null responders.  Group III: 20 normal persons (as control group). Attending to the hepatology and virology treatment center of Damanhour Medical National Institute. After evaluation of each patient and applying exclusion criteria,and after full history taking, complete clinical examination, laboratory investigations, abdominal Ultrasound, liver biopsy, neasurement of serum levels of Neopterin by ELIZA technique before and at week 12 of treatment. Neopterin is a more sensitive marker for severity of liver disease than established markers of inflammation, its concentration usually correlate with the extent and activity of the disease, and are also useful to monitor during therapy in these patients. Measurement of neopterin concentrations in body fluids can be a reliable indicator of the cellular immunological response in hepatitis C virus infection more over enhanced concentration of neopterine have been shown to have prognostic significance and monitoring stimulatory therapy.It is suggested that serum neopterin levels can be used as a significant parameter for the differential diagnosis of non-infectious hepatitis and viral hepatitis. Neopterin might be used as a marker to predict the response to antiviral therapy (pegylated-interferon- (pegIFN) combined with ribavirin) in HCV patients. A “neopterin test” is cost-effective, helpful in both HCV1 and HCV4 and HCV2 and HCV3 genotypes, and less invasive than liver biopsy. Mean and median pretreatment Neopterin concentrations were lower in patient with sustained virological response than in null responder. Our study revealed that: Serum neopterin level was significantly elevated in patients with chronic hepatitis C virus compared to healthy control individuals. Neopterin level w