Biochemical aberrations, viral genotypic patterns and viral loads among Sudanese patients with chronic hepatitis C virus infection

Hepatitis C virus infection is a global public health problem and a leading cause of acute and chronic liver disease. HCV is a small, single-stranded RNA virus of the Flaviviridae family that can infect hepatocytes, lymphocytes and monocytes. It is classified into eleven genotypes and 67 subtypes on genetic differences. Hepatitis C infections can be concentrated in certain populations and/or in general populations.1–4 HCV is transmitted through needle sharing, contaminated surgical equipment, blood transfusion, sexual contact and from infected mothers to babies. Variable low to high prevalence (1.3%-55%) of HCV in patients with hepatocellular carcinoma or chronic liver disease have been reported form different African countries.5–7 The global prevalence of anti-HCV has been estimated at 2.0% (1.7–2.3%) among adults and 1.6% (1.3–2.1%) for all ages with an estimated 115 million people infected mainly adults. HCV infection is not preventable by vaccination, so improved surveillance and access to screening and treatment at national and regional levels are strongly recommended.8–14 Sudan is the largest country in the Nile valley with a land mass about the size of Europe with HCV infection prevalence among asymptomatic male Sudanese blood donors of 1.5%-4.4%. This is definitely an under-estimate since females do not usually donate blood in Sudan. The highest prevalence [66.7%] of HCV infection in Sudan was noted in patients with end-stage renal disease on regular hemodialysis.2,15 Early diagnosis and treatment of HCV infection minimize risks of both long-term complications and transmission of infection. HCV infection is usually diagnosed by the detection of anti-HCV antibodies in a patient’s serum that react to recombinant HCV proteins in ELISA or chemiluminescence immunoassays.16,17 However, various biochemical and molecular markers are now available that can be used in screening for hepatitis C infection, for both diagnosis and monitoring chronic HCV infection. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are routinely employed for the initial assessment and monitoring of hepatic disease.7,16–20