HEPATITIS-C VIRUS-INFECTION IN SCHISTOSOMIASIS-MANSONI IN BRAZIL

The involvement of the hepatitis C virus (HCV) in the severity of live r disease in chronic schistosomiasis was investigated in 215 Brazilian patients with S. mansoni infections, but without evidence of hepatiti s B surface antigen (HBsAg). Forty-three had hepatointestinal (HIS) an d 172 had hepatosplenic schistosomiasis (HSS), and 135 had compensated (HSSC), and 37 had decompensated (HSSD) liver disease. Fifty-two (24% ) were found to have evidence of HCV infection (seropositive for anti- HCV antibodies and/or HCV-RNA). These comprised 35 (95%) of the 37 wit h HSSD, 16 (12%) of the 135 with HSSC, and 1 (2.4%) of the 43 with HIS , compared with only 1 (2%) of 50 control patients without S. mansoni. Testing of matched liver tissue and peripheral blood mononuclear cell s (PBMCs) from 25 patients (6 HSSC and 19 HSSD) with HCV infections sh owed that 17 (68%) had ''active'' viral infections, in that negative s trand HCV-RNA (the presumed replicative intermediate of the virus) cou ld be detected in liver and/or PBMCs. Among these 25, negative strand HCV-RNA was found in 16 (84%) of the 19 with chronic active hepatitis, but in only 1 (17%) of the 6 with mild or inactive disease (P < 0.01) . HCV-RNA was detected in matched spleen specimens from 9 of 10 patien ts (all of whom were also positive in PBMCs), suggesting that the sple en is an important extrahepatic reservoir of the virus. The findings i ndicate that concomitant infections with HCV a re a major factor contr ibuting to the severity of liver disease in chronic schistosomiasis, a nd that apparent active replication of the virus in the liver or at ex trahepatic sites is strongly associated with severe liver disease. (C) 1995 Wiley-Liss, Inc.