Spontaneous viral clearance of chronic HCV infection in Upper Egypt: A community-based study with a 10 year follow-up

Background and study aimsHepatitis C virus (HCV) infection is a global blood-borne disease with the highest prevalence in Egypt. The natural course of HCV infection is highly variable. The reason why the infection persists in some patients and resolves spontaneously in others is not known. The aim of this study was to detect the frequency of spontaneous clearance of chronic HCV infection in Upper Egypt and to determine the predictors of persistence of HCV infection.Patients and methodsIn 1997, a community-based study was performed in Sallam village in Upper Egypt. Out of the 329 patients who had positive HCV-RNA, 200 patients were included in this study, after excluding cirrhotic patients at the start of the study and those who had received specific treatment for HCV infection. These patients were followed up every six months prospectively starting from 2004 till 2007 by clinical, ultrasonographic, and laboratory examinations (liver functions, complete blood count, prothrombin time and concentration). Serum HCV-RNA was tested for at the end of the follow up period.ResultsAfter a 10-year follow-up, spontaneous clearance of chronic HCV infection was detected in 35 (17.5%) out of 200 patients. Most of clinical and laboratory abnormalities were detected in patients with HCV-RNA persistence than those who had cleared HCV-RNA. By ultrasonographic examination, normal liver echopattern was found in 30 (85.7%) cases with HCV-RNA clearance and in 75 (45.5%) patients who had HCV-RNA persistence. Evidence of liver cirrhosis was found only in 9 cases with HCV-RNA persistence (5.5%). Old age (>60 years) was the strongest predictor of persistence of HCV infection followed by obesity and history of blood transfusion.ConclusionsSpontaneous clearance of chronic HCV infection could occur without any specific antiviral therapy in 17.5% of patients. Older age was the strongest predictor of persistence of HCV infection followed by obesity and infection by blood transfusion.