{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:57:48Z","timestamp":1753869468113,"version":"3.41.2"},"reference-count":56,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T00:00:00Z","timestamp":1702857600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The infection caused by the hepatitis C virus (HCV) is a significant global health concern. The prevailing genotype of HCV in Egypt is 4a, commonly referred to as GT\u20104a. A significant proportion exceeding 50% of patients infected with HCV experience extrahepatic manifestations (EHMs), encompassing a diverse range of clinical presentations. These manifestations, including essential mixed cryoglobulinemia (MC), can serve as initial and solitary indicators of the disease. The complete understanding of the pathogenesis of EHM remains unclear, with autoimmune phenomena being recognized as the primary causative factor. In this study, we examined the predictive significance of T\u2010cell subpopulations in relation to the occurrence and prognosis of cryoglobulinemia in HCV patients. A total of 450 CHC genotype four treatment na\u00efve patients were enrolled in this analytic cross\u2010sectional study after thorough clinical, laboratory, and radiological examinations. All patients underwent laboratory investigations, including testing for cryoglobulin antibodies and measurements of CD4 and CD8 levels; two groups were described according to their test results: Group 1 consists of patients who have tested positive for cryoglobulin antibodies and Group 2 consists of patients who have tested negative for cryoglobulin antibodies. The exclusion criteria encompassed individuals with HIV infection or chronic HBV infection. Additionally, pelvi\u2010abdominal ultrasonography was performed. Our study included 450 treatment na\u00efve CHC patients (59% male, mean age 50.8 years). The patients were categorized according to their cryoglobulin antibodys test results into two groups: group A, CHC patients with cryoglobulin antibodies (Abs) negative (364 patients), and group B, CHC patients with cryoglobulin Ab positive (86 patients). Group B demonstrated a higher average age, elevated international normalized ratio, more prolonged duration of HCV infection, lower albumin, higher alanine aminotransferase, higher aspartate aminotransferase, higher bilirubin, lower CD8, lower CD4, and lower CD4:CD8 ratio. In contrast, 27 out of 86 (31.40%) patients in group B had symptoms; 85.8% had purpura and arthralgia, 74.3% had paresthesias, 86.7% had weakness, and 12.2% had non\u2010Hodgkin's lymphoma. The levels of CD4 and CD8 were found to be decreased in chronic HCV patients with MC. T\u2010cell subpopulation serves as a reliable indicator for assessing the prevalence and prognosis of MC in individuals with genotype 4 chronic hepatitis C. However, additional research is needed to further understand the development and spread of various emerging infectious diseases. Nevertheless, it is noteworthy that a critical threshold may exist beyond which EHM reaches a point of no return.<\/jats:p>","DOI":"10.1002\/jmv.29248","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T15:09:29Z","timestamp":1702912169000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A multicentric and nationwide predictive study role of T cell sub\u2010population in the prevalence and prognosis of cryoglobulinemia among genotype 4 chronic hepatitis C patients"],"prefix":"10.1002","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8970-0286","authenticated-orcid":false,"given":"Mohamed","family":"Abdel\u2010Samiee","sequence":"first","affiliation":[{"name":"Department of Hepatology and Gastroenterology, National Liver Institute Menoufia University Shebin El\u2010Kom Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed I.","family":"Youssef","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine Al\u2010Azhar University Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fathy","family":"Elghamry","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine Al\u2010Azhar University Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Bazeed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine Al\u2010Azhar University Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Al\u2010Shorbagy","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Faculty of Medicine Al\u2010Azhar University Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helmy","family":"Shalaby","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine Al\u2010Azhar University Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hossam","family":"Shabana","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine Al\u2010Azhar University Cairo Egypt"},{"name":"Department of Internal Medicine, College of Medicine Shaqra University Dawadmi Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3225-7164","authenticated-orcid":false,"given":"Eman","family":"Abdelsameea","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology, National Liver Institute Menoufia University Shebin El\u2010Kom Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hesham El Sayed","family":"Lashin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine Al\u2010Azhar University Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7941-6399","authenticated-orcid":false,"given":"Hossam M. 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