RE: Prevalence of hepatitis C virus infection and human immunodeficiency virus in a cohort of Egyptian hemophiliac children

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.