Relationship between hepatitis C virus infection and schistosomal liver disease: not simply an additive effect

Background. To study the association, clinical significance, and impact of hepatitis C virus (HCV) coinfection in patients with schistosomal liver dis ease (SLD). Methods. A total of 240 patients with chronic liver diseases en countered consecutively were enrolled in the study. Fifty volunteer blood d onors were enrolled as controls. HCV antibody determination (enzyme-linked immunosorbent assay), qualitative and quantitative HCV RNA assay (reverse t ranscriptase polymerase chain reaction), and HCV genotyping (line probe ass ay) were performed. Results. Twenty-eight patients had SLID alone, 60 had b oth SLID and chronic hepatitis C (CH-C), 120 had CH-C alone, and 32 had oth er liver diseases. The positivity rates for HCV antibody (76% vs 20%; P < 0 .001) and HCV RNA (59% vs 10%; P < 0.001) were significantly higher in the patients with SLID (n = 88) than in the volunteer blood donors (n = 50). Co mplications of liver cirrhosis were more common in patients with concomitan t SLID and CH-C than in those with either SLID or CH-C alone. The mean leve ls of alanine aminotransferase (77 +/- 42 vs 93 +/- 55 IU/l; P = 0.049) and HCV RNA concentrations (3.5 +/- 1.0 vs 4.2 +/- 1.0 log copy/ml; P < 0.001) were significantly lower in patients with concomitant SLD and CH-C than in those with CH-C alone. HCV genotype 4 predominated in both these groups (9 3% and 98%). Conclusions. SLID in Egypt is significantly associated with HC V infection, with the predominance of genotype 4. Concurrent HCV infection and SLD result in much more severe liver disease than that seen with either disease alone. However, the activity of HCV infection seems to be partiall y suppressed in patients with SLD.