الفهرس 
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Abstract
Hepatitis C virus infection is an important health problem in Egypt and worldwide as it accounts for most cases of CLD and HCC. Genotype 4, which is found primarily in the Middle East and Central Africa and has a worldwide prevalence of 2% comprises the most predominant genotype in Egypt (>90%) (Kurbanov et al., 2011; Khattab et al., 2011). Spontaneous clearance of HCV infection occurs in approximately 30% of acute infections while majority ends up with CHC unless treated, with SVR varying with host and viral factors, timing of starting therapy and status of patient at time of starting therapy. Treatment success rates are higher when individuals are treated during acute HCV than when they are treated during chronic infection. The treatment in cases of CHC is associated with significant side effects and high cost. To be able to decide whether early treatment is indicated, early predictors of spontaneous viral clearance are urgently needed (Van den Berg et al., 2011). Our study aimed at monitoring the outcome of AHC patients either who had spontaneously cleared the virus or who would be treated with pegylated IFN-a plus ribavirin for 24 weeks and to study the factors that might affect this outcome. The study was conducted on 28 patients diagnosed with AHC over a period of 17 months from June 20 1 1 to February 20 14. Patients were recruited fiom the inpatient and outpatient clinic of Hepatology department, National Liver Institute, Menoufiya University and patients referred fiom fever hospitals and hepatologists’ private clinics all over the country. Patients were divided into two groups; Group 1 included patients who had complete resolution within 16 weeks after presumed time of infection and Group 2 included patients who failed to spontaneously clear the virus and required treatment. Treatment regimen was pegylated IFN-a2b, 1.5 y glkglweek plus RBV 1 5mgIkglday for 24 weeks. We found that The mean age of patients was 37.5 * 11.7 years old (range; 21 to 67) years old. The mean age of patients with spontaneous clearance was 33.5 * 10.7 years old while the mean age of patients who didn’t spontaneously clear the virus was 44.7 * 13 years old. The mean of incubation period was 49.6 * 44.4 days with the range of 14 and 197 days. Risk factors and possible causes of infection were: recent surgery in 35.7% (n= lo), dental procedures in 14.3% (n= 4), needle-stick injury in 7.2% (n= 2), recent endoscopy in 7.2% (n= 2), blood and blood products transfusion in 14.3% (n= 4), hospital admission with no history of surgery or blood or blood product transfusion in 3.5% of patients (n= 1) and unknown in 17.9 % of patients (n= 5). At baseline, 50% of patients were positive for HCV antibody while the other half was negative for HCV antibody. At the 12th week, all the studied patients were positive for HCV antibody. Females represented 67.9% (19 patients) of the total number of studied patients while males represented 32.1% (9 patients). Female gender was found to have 82.3% (n=14) spontaneous clearance rate. Seventeen patients (60.7%) had spontaneously cleared the virus within the first 16 weeks of follow-up while 11 of patients (39.3%) failed to spontaneously clear the virus and required treatment with peg-IFN in combination with RBV for 24 weeks. Six patients finished treatment course while five patients is still under treatment. Five patients who completed the 24-week-course of treatment achieved an ETR (83.3%). Only one patient didn’t achieve ETR. Patients with IL-28B SNP CC alleles represented 67.9% of the studied patients (n= 19) of them, 63.1% (n=12) had cleared the virus spontaneously. There was positive correlation between patients who had spontaneously cleared the virus and patients who received treatment as regards age, gender, IP, IL-28B SNP (P < 0.05) and also as regards baseline HCV antibody status, HCV RNA level, ALT, AST, bilirubin and albumin ( P < 0.0 1). There was a negative correlation between patients who had spontaneously cleared the virus and patients who received treatment as regards serum creatinine (P > 0.05). Our study was limited by the small number of AHC cases that could be identified over the 17-month study period (n=28) because the majority of HCV-infected individuals remain asymptomatic and because AHC symptoms are no different from any acute hepatitis clinical picture thus, most cases are missed in sets of clinical practice.