الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Egypt has the largest burden of HCV infection in the world, with a 10% prevalence of chronic HCV infection among persons aged 15–59 years.HCV transmission in Egypt is associated primarily with inadequate infection control during medical and dental care procedures. In response, the Egyptian Ministry of Health and Population (MOHP) in 2001 implemented a program to reduce health-care–associated HCV transmission and in 2008 launched a program to provide care and treatment. Infection control programs implemented in 2001 at MOHP facilities resulted in improvements in infec¬tion control practices and a decrease in the annual incidence of HCV infection among dialysis patients from 28% to 6%.
Hepatitis C virus (HCV) genotype 4 is the most frequent cause of chronic hepatitis C in the Middle East, North Africa, and sub-Saharan Africa .Various studies from European and Middle Eastern countries showed that the sustained virological response in genotype 4 for combi¬nation therapy, pegylated interferon and ribavirin, rang¬es between 43%-70%.
Globally, an estimated 130–180 million persons (2%–3% of the world’s population) are living with hepatitis C virus (HCV) infection. This infection, particularly in its chronic form, is associated with sizable morbidity and mortality. More than 350,000 deaths are attributed to HCV infection each year, most of which are caused by liver cirrhosis and hepatocellular carcinoma (HCC) .
The goal of treatment in patients with chronic hepatitis C virus (HCV) infection is to eradicate hepatitis C virus (HCV) RNA, which is predicted by the attainment of a sustained virologic response (SVR). An SVR is associated with a 99 percent chance of being HCV RNA negative during long-term follow-up.
In the last decade, treatment with pegylated interferon 2a or 2b (pegIFN) combined with weight-based ribavirin (RBV) for 48 weeks (genotypes 1, 4, 5 and 6) or 24 weeks (genotypes 2 and 3), has been considered the standard of care (SOC) for HCV treatment.
The aim of this work was to evaluate the clinical utility of interferon Lambda-3 polymorphism rs12979860 of 3 kb upstream (CC & CT & TT), as a predictor of viral clearance and treatment response in patients receiving pegylated interferon /ribavirin therapy as standard of care (SOC) treatment.
A total of 100 patients who were to be eligible for the study; they had chronic HCV infection and they were candidate for antiviral therapy in the form of PEG-IFN/RBV (the SOC therapy), and at the same time they had no contraindications for antiviral treatment. They were classified into two groups according to be responders or non-responders:
I- Group ”A”: They were responders with rapid virological response (RVR) which means undetectable HCV RNA level after 4 weeks of SOC therapy.
II- Group ”B”: They were non-responders which mean the HCV-RNA was detected with less than 2 log10 reduction of the level of viremia at 12 weeks of SOC therapy.
1- Age is a contributing factor to treatment outcome. Gener¬ally, people under 40 years old respond better to current HCV treatments than people over 40 years old. In the current study, the response rate was more in patients who were aged from 25 years to 60 years with a Mean±SD = 48.9±5.3, whilel non-responder status was higher in patients who were aged from 37 to 59 years with a Mean±SD = 47.6±6.2, which refleced that the younger patients were more responding to treatment than elderly one.
2- In the present work according to the gender of patients who were enrolled in the study, in responders group, there were 39 patients males (57.4 %) & 29 patients females (42,6%) and all of them were resopders. So, the response in males was more than in females. In non-respoder group, the males were more non-responder than females. This study suggested that women and men react differently to combined therapy.
3- As regard to the presence or absence of diabetes mellitus and its impact upon the treatment response. The type -2 diabetes developed due to either insulin deficiency or insulin resistance or both. One of the host factors which predict response to antiviral therapy is insulin resistance. In the current study, there were 15 patients who were diabetics and 10 of them were responders and 5 were non-responders. So, the effect of diabetes on respose rate will need more studies. Patients with HCV who demonstrate insulin resistance tend to have a lower SVR rate.
4- According to the risk factors of HCV infection, the current study showed that a 33 HCV patients had a history of blood transfusion , and 44 HCV patients had a history of dental work that was mean that the risk factor was higher in patients who get dental work which means that the frequency of dental procedure was higher than blood transfusion (quantativly), but the blood transfusion was more risky (qualitatively), the addiction in the current study was critical and the absence of addiction in the patients who were enrolled in the study did not mean that the addiction was not a risk because the patients meight have medico legal reason .