title: Coinfection with hepatitis C virus and schistosomiasis: fibrosis and treatment response.
abstract: OBJECTIVE
  To assess whether schistosomiasis coinfection with chronic hepatitis C virus (HCV) influences hepatic fibrosis and pegylated-interferon/ribavirin (PEG-IFN/RIB) therapy response.
  
  
  METHODS
  This study was designed as a retrospective analysis of 3596 chronic HCV patients enrolled in the Egyptian National Program for HCV treatment with PEG-IFN/RIB. All patients underwent liver biopsy and anti-schistosomal antibodies testing prior to HCV treatment. The serology results were used to categorize the patients into group A (positive schistosomal serology) or group B (negative schistosomal serology). Patients in group A were given oral antischistosomal treatment (praziquantel, single dose) at four weeks prior to PEG-IFN/RIB. All patients received a 48-wk course of PEG-IFN (PEG-IFNα2a or PEG-IFNα2b)/RIB therapy. Clinical and laboratory follow-up examinations were carried out for 24 wk after cessation of therapy (to week 72). Correlations of positive schistosomal serology with fibrosis and treatment response were assessed by multiple regression analysis.
  
  
  RESULTS
  Schistosomal antibody was positive in 27.3% of patients (15.9% females and 84.1% males). The patients in group A were older (P = 0.008) and had a higher proportion of males (P = 0.002) than the patients in group B. There was no significant association between fibrosis stage and positive schistosomal serology (P = 0.703). Early virological response was achieved in significantly more patients in group B than in group A (89.4% vs 86.5%, P = 0.015). However, significantly more patients in group A experienced breakthrough at week 24 than patients in group B (36.3% vs 32.3%, P = 0.024). End of treatment response was achieved in more patients in group B than in group A (62.0% vs 59.1%) but the difference did not reach statistical significance (P = 0.108). Sustained virological response occurred in significantly more patients in group B than in group A (37.6% vs 27.7%, P = 0.000). Multivariate logistic regression analysis of patient data at treatment weeks 48 and 72 showed that positive schistosomal serology was associated with failure of response to treatment at week 48 (OR = 1.3, P = 0.02) and at week 72 (OR = 1.7, P < 0.01).
  
  
  CONCLUSIONS
  Positive schistosomal serology has no effect on fibrosis staging but is significantly associated with failure of response to HCV treatment despite antischistosomal therapy.
authors.affiliation: Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt.
authors.forename: Mahasen
authors.initials: M
authors.lastname: Abdel-Rahman
authors.forename: Mohammad
authors.initials: M
authors.lastname: El-Sayed
authors.forename: Maissa
authors.initials: M
authors.lastname: El Raziky
authors.forename: Aisha
authors.initials: A
authors.lastname: Elsharkawy
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Akel
authors.forename: Hossam
authors.initials: H
authors.lastname: Ghoneim
authors.forename: Hany
authors.initials: H
authors.lastname: Khattab
authors.forename: Gamal
authors.initials: G
authors.lastname: Esmat
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D060085:Coinfection; D004359:Drug Therapy, Combination; D004534:Egypt; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000209:etiology* / Q000469:parasitology / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011223:Praziquantel / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D012552:Schistosomiasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012556:Schistosomicides / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012556:Schistosomicides; D011092:Polyethylene Glycols; D012254:Ribavirin; D011223:Praziquantel; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a
keywords: Coinfection; Fibrosis; Hepatitis C virus; Schistosomiasis; Treatment response