الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
HCV has been encountered worldwide with World Health Organisation (WHO) estimates of more than 170 million infected patients in total; 130 countries and up to 90% of these will progress to chronic liver disease.
Interestingly, genotype 4 represents over 90% of cases in Egypt. Chronic HCV is the main cause of liver cirrhosis and primary liver cancer in Egypt. (Arafa et al., 2005).
PEG IFN plus Ribavirin was more effective than standard interferon-ribavirin combination or PEG IFN alone. SVR rates were similar with both forms of PEG- interferon (α-2a and α-2b) when used in combination with ribavirin(Shiffman et al., 2010).
Vitamin D is a potent immune modulator that is related to severity of hepatic fibrosis and responsiveness to antiviral therapy (Petta et al., 2010).
The impact of vitamin D supplement on SVR of pegylated interferon\ ribavirin-based treated patients is unknown. Recent data reported that vitamin D supplement can improve virological response to antiviral therapy (pegylated interferon/ribavirin) in genotype 1 infected CHC patients(Abou Mouch et al., 2010).
The main aim of our work is to study the effect of vitamin D level on the response of HCV to PEG interferone and ribavirin in the studied diabetic group as the first step screening for the role of vitamin D level for possibility of adding vitamin D to treatment of hepatitis C virus infection
This study was conducted in Kafr el sheikh liver and cardiac center and Benha University hospital , it included forty diabetic patients with proven chronic hepatitis C who have not been treated with any form of interferon, and fulfill criteria of receiving interferon/ribavirin therapy.
Before treatment all patients were sampled for measuring vitamin D serum levels by 25(OH) Vitamin D direct Immunodiagnostic ELISA Kit and Full clinical evaluation by detailed history and physical examination. And other laboratory tests including measurements HCV-Ab, HBS-Ag (those with HBS-Ag excluded from the study) and quantitative PCR for HCV–RNA.
1. In addition to evaluation of CBC (Hb >11 g/dl), Absolute neutrophil count >2.000/mm3 , Platelets >100,000/mm3, prothrombin time and concentration (n=70-100%), serum albumin (n=3.5-4.5 g/L), total serum bilirubin (n=up to 1.4 mg/dl), TSH (n=0.4-4.5 µIU/ml), AFP up to 10, if AFP is abnormal but still < 100 IU/ml, C.T should be normal. fasting blood sugar within normal range (70-110 mg/dl).
2. Abdominal ultrasound and Liver biopsy according to (Ishak et al.,1995) to determine grade of necroinflamation and stage of liver fibrosis to determine their eligibility for antiviral treatment.
There were forty patients are known to be diabetic . all of them received the usual regimen of interferon [pegylated-interferon subcutaneous (peginteron 150 mcg) ] weekly and oral ribavirin (800-1200 mg/d;.Follow up of patients after 12 weeks for vitamin D3 level and its relation to response of therapy and developing side effects .
The results of this study revealed that most of CHC patients have low vitamin D serum level in the studied diabetic group , varied from mild to severe deficiency and the advanced degree of fibrosis was associated with lowest vitamin D serum levels .
Also in mild deficiency at 12 th week all have negative PCR while in severe deficiency 6/32 patients have positive PCR at 12 th week the result was insignificant but give a message to investigate on larger number of patients and also there was more decreasing in level of vitamin D at 12 th week than 1 st week . It may be related to interferon and ribavirin effect.