This multi-center study was designed as a trial to explore the frequency of silent
hepatitis B infection among hepatitis C patients and to determine the prevalent
genotype of hepatitis C virus (HCV) in these patients. The study comprised 45
patients with post-hepatitic liver cirrhosis. All patients gave blood samples for
estimation of liver function tests and ELISA estimation of serum levels of hepatitis B
surface antigen (HBsAg) and anti-HCV antibodies; patients with HBsAg positive
were excluded off the study. Qualitative detection of HCV RNA and HBV DNA by
PCR (home-made PCR) and quantitative PCR for estimation of HCV viremia and
HCV genotyping by RFLP technique were performed. The HCV-Ab was detected in
all samples irrespective of its clinical severity class with a mean viremia level of
792336.7±400074.8; range: 134985-1957632 viral copy/ml as determined by
quantitative PCR with a non-significant difference between clinical severity classes as
regards viremia level. The HBV DNA was detected using qualitative PCR in 20
samples (44.4%); 4 class A, 7 class B and 9 class C samples with a significant
increase of the frequency of silent HB in patients with class B (X2=5.446, p<0.01)
and C (X2=8.154, p<0.001) in comparison to class A patients. Genotyping of HCV
reported 41 samples (91.1%) with genotype-4 and 4 samples (8.9%) with genotype-1
with a prevalence rate of HCV genotype-4 was 91.1%. There was positive nonsignificant
correlation between both HCV genotype and the presence of silent
hepatitis B infection and clinical severity, however, using the receiver operating
characteristic (ROC) curve analysis judged by the area under the curve (AUC) to
evaluate the sensitivity and specificity of detection of silent hepatitis B infection and
identification of HCV genotype as predictors of severe hepatitis showed a nonspecific
role for genotyping for prediction of severity with AUC=0.467, while the
detection of HBV DNA using PCR in patients with HCV infection is a specific
predictor of severity with AUC=0.617. It could be concluded that HCV genotype-4 is
the most prevalent type in Egyptian Hepatitis C cirrhotic patients with an incidence of
silent hepatitis B of 44.4% and its detection is a specific predictor of severe cirrhosis.