The Hepatitis C virus (HCV) affects 170 million people worldwide. In between 55 and 85% of acutely infected patients, HCV successfully evades the host's immune response, resulting in chronic infection. Hepatitis C has a very varied natural history; the origins of this diversity are unknown but are linked to virus, host, and environmental factors [1]. 

Non-A, non-B hepatitis was once called as hepatitis. When Choo and colleagues [2] first identified HCV, it was already responsible for over 90% of instances of post-transfusion hepatitis [3]. One of the world's worst health problems is chronic hepatitis C. Even while some people may not have any symptoms for decades, 20% of those who are chronically infected are at risk for serious liver diseases including cirrhosis and liver cancer [4]. In up to 44% of new infections, no risk indicators for HCV infection over the preceding six months may be recognized [5]. 

After thorough questioning, however, the vast majority of these patients admit to engaging in high-risk activities in the past (including injectable drug usage) [6]. Before screening became common, getting HCV was most likely to happen if you got a blood transfusion or used injection drugs. Between 1990 and 1992, people who gave blood were tested for HCV antibodies. The number of HCV infections caused by blood transfusions has dropped sharply, and now there is less than one case for every 2 million units given [7-8]. Chronic hemodialysis is also linked to higher HCV infection rates. Anti-HCV antibodies are found in 11.6% of hemodialysis patients in the United States, but in Jordan, Saudi Arabia, and Iran, the number is between 55 and 85% [9]. Even though the risk of passing on the HCV virus is low in monogamous relationships, the risk goes up with the number of sexual partners and the level of HCV viremia. Around 2% of spouses have HCV antibodies [10]. Other than activities like sharing a razor or toothbrush that can expose blood, there is no reason to cease completing typical household tasks.

It has also been hypothesised that some folk medical techniques (acupuncture, ceremonial scarification), body piercing, tattooing, and even professional barbering provide a risk for HCV transmission [11-12]. The risk of transmitting HCV to an unborn child is minimal, ranging from 5.1 to 6.7% for HCV-only carriers and being two to three times greater for carriers of both HCV and HIV [13] Even though they don't have any other risk factors, alcoholics have high rates of hepatitis C virus (HCV) infection (about 30%) [14-15]. HCV may accelerate liver damage in heavy drinkers [16], alcohol seems to reduce the efficiency of HCV interferon treatment [17], and individuals who have had a liver damage caused by alcohol or HCV are more prone to develop hepatocellular carcinoma [18]. 

The current study aims to study the distribution of this virus depended on gender, age, source of infection, determine the genotype and viral load, as well as assess the response to antiviral treatments and its relationship to the level of cortisol.

Between January 2022 and March 2022, 553 individuals with a positive HCV Ab test who attended the outpatient clinic of the gastrointestinal and teaching hospital were included in our research. Every patient has had a full medical history and a thorough clinical exam. The medical history has been mostly about these things: 

Infection risk factors (blood transfusion, surgery, etc.) Household exposure to the same illness. Any indication of liver illness, including jaundice, subcostal pain, and weariness. 

Complete clinical evaluations were performed on each patient. Total serum bilirubin (TSB), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were evaluated to evaluate liver function. PT, INR. Albumin protein in blood serum. HCV Ab positive was measured with an enzyme-linked immunosorbent test of the type III kind. Other possible causes of liver disease are ruled out (HBsAg, immunological screening, etc.).

An skilled sonographer performed abdominal ultrasonography on all patients, noting liver size, texture, spleen size, and ascites. Patients with hepatic cirrhosis had alpha fetoprotein tested. cortisol hormone determined using Cobas e 411 (GERMANY) utilising (ROSCH) detection kits in accordance with the manufacturer's instructions.

Hcv Rna Detection 

Both the production of HCV RNA and the synthesis of cDNA were carried out in the same manner as was described earlier [11]. The extracted RNA was employed as a template for nested RT-PCR using HCV 5UTR-specific primers (5 non-coding region) [12-13]. Negative controls without a template were introduced to each pair of primers throughout the same cycling procedure. If a control sample tested positive, the PCR results were rejected. Ehtydium bromide was used to stain cDNA amplification on a 2.0% agarose gel.

Genotyping of Hcv 

Primers specific for HCV genotypes 1, 2, 3, and 4 were used to amplify the core region and determine the various HCV genotypes [15-16]. A 272 base pair (bp) HCV core gene fragment was amplified from cDNA using universal primers. PCR amplification was performed on a subset of the sample using primers designed to amplify a specific region of the HCV core (HCV-C) gene for each of genotypes 1, 2, 3, and 4. [14-15]. The PCR sizes indicated the differences between the four genotypes: 123 bp for genotype 1, 211 bp for genotype 2, 240 bp for genotype 3, and 188 bp for genotype 4.

Statistical Analysis

Data was encoded and entered using SPSS 14 variable relationships. p0.05 is significant using Chi-Square.

There were a total of 553 patients who visited the outpatient clinic at the Gastroenterology and Hepatology Hospital and tested positive for HCV Ab throughout the study's time period. Most of our patients were found to have HIV by accident when they gave blood, were tested before an intervention, were tested for life insurance, were in a high-risk group, or were in contact with medical staff or people in their homes. As it is clear in (Table 1). 

Table 1: Methods for Diagnosing HCV

90 patients have finished treatment. 66 (73.3% of the patients) were men, and 24 (26.7% of the patients) were women. The ages of the patients ranged from 18 to 63 years, with the average age being 41.4 years. Most of the patients were between 18 and 40 years old.

Twenty (22.2%) of the patients (out of a total of 90) had abnormal liver enzyme levels. (Table 2) Patients are split into two categories based on their viral loads, with only 27 (or 30 percent) having loads that are over 600,000 copies per millilitre and 63 (or 70 percent) having loads that are below that threshold. Genotype 1 or 4 patients, those with normal liver function tests and ultrasounds, and 39 other patients (42.2%) have all had liver biopsies. (Table 3) shows that 80 (88.9%) of the people have an early virological response (EVR), whereas 69 (76.2%) have a complete early virological response and 11 (13.75%) have a partial response 

Table 2: The distribution of liver enzymes in HCV patients

Normal value <40iu/ml

Table 3: Liver enzyme levels in relation to viral load

p = 0.028

(c EVR). However, since they had high viral loads, elevated levels of liver enzymes, and two of them showed histological signs of deteriorating liver disease, we chose to continue treating the 10 patients even if they did not show an early virological response (2log decline in viral load). Only 34 (37.7%) of patients who successfully completed therapy attained end-treatment response (ETVR).

Estimation of Cortisol Concentration

The results of the current study showed the determination of the concentration of cortisol compared to the viral load.

The results showed in (Table 4) a significant increase in cortisol concentration for the patients group with a viral load >600,000 iu/ml (267.89±16.60 ng/ml) compared with other groups, group viral load of <600,000 (126.84±4.55ng/ml) and the control group (123.06±6.13 ng/ml).

Table 4: Cortisol concentration distribution in the examined groups

* At the 0.05 level of significance, there is a significant difference when comparing two independent means using the student's t test.

Despite the fact that the national incidence rate is still under 0.3%, our health centre has observed an uptick in cases because to a ministry of health initiative that mandates testing for all patients prior to intervention surgery. Routine testing before elective surgery or interventional medicine, blood donation, screening of infected people's families, or testing of chronic renal failure patients receiving hemodialysis revealed HCV Ab+ve in the vast majority of cases [19]. As a result, we must highlight the need of screening at-risk persons as well as making the test freely available to the general community [8-13]. According to prior studies, the majority of patients participating in our research were male (66.3%) compared to female (26.7%). The rationale for this disparity between male and female may be found in the fact that in our community, fewer women are exposed to HCV Ab screening tests than males, and the majority of blood donors are men.

More quicker development to cirrhosis and HCC is related with male gender. It is unclear why this link exists, however hormonal impacts on fibrogenesis have been postulated as a possible explanation. Activation andproliferation of hepatic stellate cells are both inhibited by oestrogen in vitro. Moreover, postmenopausal women tend to have a fibrosis acceleration.

Our research included patients between the ages of 18 and 63, with a mean age of 41, 4 years. The majority of our patients fell among the young and middle age groups. Males may be exposed to infection more than females, especially through the use of razors or frequent travel and contact with occupational hazards [14,18]. However, other studies attribute the causes of this variation to genetic factors related to the susceptibility of any sexes to infection based on the genotype of the viruliferous virus [9]. According to Soulsby [13], sex hormones have an influence on infection. He said that male hormones cause cellular immunity to decrease, whilst female hormones cause cellular immunity to increase. Additionally, sex hormones have an effect.

The findings of the present investigation displayed that HCV prevalence is higher in persons within age group (31-50) years than in older or younger persons, and that is agreement with [4,6]. Exposure of this group to the various medical device for treating and donation of blood is the leading cause of infection. The reason for decrease of infections in age groups older than (30-49) years was the death due to liver failure. In contrast the reasons for decreasing of infections in the age groups below this age group are the improvement conditions of blood transfusion and the use of sterile apparatus also many routes of HCV acquisition are absent at the childhood such as sexual contact and occupational risks [19]. There were quite modest viral loads in the majority of our patients, with less than 600,000 iu/ml in 63 of them (70%) and more than 600,000 iu/ml in 27 of them (30%). As was seen in previous studies, there was no significant link between the amount of virus before treatment and the age of the patient when they were first seen. When the viral load was low before treatment, the virological response at the end of treatment was better, and this relationship was statistically proven (p value <0.05), which was in line with what other studies had found. In this study, there was a strong link between the amount of viruses and the liver enzymes, as shown in (Table 4). Other studies have also observed similar link. 50% of patients had genotype 1, followed by 36.7% with genotype 4. This is comparable to previous studies conducted in our nation and in neighbouring regions such as Turkey and Iran, but distinct from Syria [7].

Viral genotype and viral load are two significant prognostic markers that may help in treatment choices.Because ALT levels may not always represent disease activity, viral load seems to be a useful predictor of antiviral medication success. In fact, people with a high viral load respond less well to interferon therapy than people with a low viral load. Patients with high HCV RNA copy numbers before therapy are more likely to have a relapse after therapy ends. The link between HCV genotypes and viral load is still up for debate. In some studies, high titre viraemia was linked to an advanced liver stage32, but in others, there was no link between the two.

This study agrees with the work done by Abimbola and Osaba in 2002 in the Kingdom of Saudi Arabia (KSA) to find out how common HCV genotypes are in different groups of people in KSA. The most common genotype was 4, which was found in between 40% and 74% of the patients studied. Epidemiological and clinical investigations rely on HCV genotype. Sequence diversity helps explain serological reactivity and treatment response [17]. Interferon treatment results vary by HCV type/subtype, indicating that HCV has diverse pathogenic potentials [5]. Several studies have shown a link between HCV strains and liver disease severity [1]. It has been demonstrated in several of these investigations that genotypes 2 and 3 are more reliable than genotype 1 in predicting a positive therapeutic response [6]. Severity of liver disease varies with viral characteristics including genotype, viral load, and HCV quasi species heterogeneity, as well as host variables like age, sex, alcohol intake, and duration of HCV infection.

In conclusion, most cases were found by accident when people gave blood or were screened before getting medical treatment. Hepatitis C was more common in men, and most of the people we saw had viral loads of less than 600,000 IU/ml. The frequency of genotype 1 was 50%, with genotype 4 in second place. The majority of our patients had early virologic response. Only 37.78% of patients had an end-treatment virological response, which shows a substantial correlation with genotype and early virological response. To enhance treatment response, efforts must be made to increase adherence to therapy, identify issues early, and address them. Additionally, individuals with high viral loads have elevated cortisol levels.

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