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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2013.81asm-1-81aCommentsRE: Prevalence of hepatitis C virus infection and human immunodeficiency virus in a cohort of Egyptian hemophiliac children Al-Mendalawi Mahmood D. From the Paediatrics Al-Kindy College of Medicine, Baghdad UniversityCorrespondence: Prof. Mahmood D. Al-Mendalawi, Al-Kindy College of Medicine, Baghdad University, P.O. Box 55302, Baghdad Post Office, Baghdad, Iraq, mdalmendalawi@yahoo.comJan-Feb 2013 33 1 81 81 Copyright © 2013, Annals of Saudi Medicine2013This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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To the Editor: Abdelwahab et al1 stated in their study that deranged liver function, particularly alanine aminotransferase (ALT) levels were significantly high in HCV-antibody and PCR positive patients as compared to HCV antibody and PCR negative ones. I presume that Abdelwahab et al solely attributed abnormal liver function to HCV as none of their patients was co-infected with HIV. I also presume that that finding needs to be considered with caution. Occult HBV infection is not uncommon in transfused immunocompromised children with HCV infection in Egypt. In a recent Egyptian study enrolling 49 children with hematological disorders and 51 with hematological malignancies,2 anti-HCV was detected among 40/49 (81.6%) children with hematological disorders (24/49; 49% HCV-RNA positive) and 9/51 (17.6%) children with malignancies (12/51; 23.5% HCV-RNA positive). HBV-DNA was positive among 38%; positive C region in 33% (15/49 and 18/51 children with hematological disorders and malignancies respectively), S region in four leukemic patients and X region in one leukemic patient. Twenty-one patients had occult HBV infection; one (2.6%) was HBeAg positive, four (19%) total HBcAb positive, 20 (95.2%) C region HBV-DNA positive and one was S region positive (1/21; 4.8%). HCV-RNA was the significant predictor for occult HBV (P<.05), with an increased frequency of HBV-DNA in the HBsAg negative (HCV-RNA positive) (63.2%) compared with patients negative for HCV-RNA (25%) (P=.009). Abdelwahab et al did not consider the possibility of concomitant occult HBV in analyzing data in their studied hemophilic patients. This point, therefore, ought to be regarded as an important limitation in their study.
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REFERENCES
1 Abdelwahab MS  El-Raziky MS  Kaddah NA  Abou-Elew HH   Prevalence of hepatitis C virus infection and human immunodeficiency virus in a cohort of Egyptian hemophiliac children Ann Saudi Med 2012 32 2 200 2 22366833 
2 Said ZN  El-Sayed MH  El-Bishbishi IA  El-Fouhil DF  Abdel-Rheem SE  El-Abedin MZ    High prevalence of occult hepatitis B in hepatitis C-infected Egyptian children with haematological disorders and malignancies Liver Int 2009 29 518 24 19192168