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Elbahrawy A, Ibrahim MK, Eliwa A, Alboraie M, Madian A, Aly HH. Current situation of viral hepatitis in Egypt. Microbiol Immunol 2021; 65:352-372. [PMID: 33990999 DOI: 10.1111/1348-0421.12916] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the major causes of viral hepatitis in Egypt as 50% or more of the Egyptian population are already exposed to HAV infection by the age of 15. In addition, over 60% of the Egyptian population test seropositive for anti-HEV in the first decade of life. HEV mainly causes self-limiting hepatitis; however, cases of fulminant hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (hepatocellular carcinoma [HCC]) in Egypt. Globally, Egypt had the highest age-standardized death rate due to cirrhosis from 1990 to 2017. The prevalence rate of HBV (1.3%-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt because HDV antibodies (IgG) vary in range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after treatment with direct antiviral agents (DAAs) are lacking. An HCC incidence of 29/1000/year in cirrhotic patients after DAA treatment is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized. Viral hepatitis is one of the major public health concerns in Egypt that needs more attention and funding from health policymakers.
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Affiliation(s)
- Ashraf Elbahrawy
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Marwa K Ibrahim
- Department of Microbial Biotechnology, Division of Genetic Engineering and Biotechnology Research, National Research Centre, Giza, Egypt.,Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ahmed Eliwa
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Madian
- Department of Internal Medicine, Al-Azhar University, Assiut, Egypt
| | - Hussein Hassan Aly
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
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Zaki M, Hazem M, Elsamman M. Shear wave elastography in assessment of liver stiffness and prediction of gastro-esophageal varices in patients with liver cirrhosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0015-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Chikhi Y, Cheraitia S, Ould Gougam R, Lounes F, Zemmouchi C, Belal N, Bendaoud M, Ait Younes S, Bensalem A, Berkane S, Asselah H, Pineau P, Lahcene M. Wide Sexual Dimorphism of Hepatocellular Carcinoma Presentation in Algeria. Gastrointest Tumors 2019; 6:122-136. [PMID: 31768356 DOI: 10.1159/000501453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022] Open
Abstract
Hepatocellular carcinoma (HCC) represents a worrying public health problem in North Africa and particularly in Egypt. The situation is unclear in western North Africa where HCC has been rarely submitted to careful scrutiny. We decided to analyze demographic, biochemical, virological, and clinical data of a series of HCC from Algerian patients to establish the landscape of this tumor in the country. In the present work, we described 337 cases of primary liver cancer from Bologhine Hospital in Algiers, the capital of Algeria. The mean age of patients was 63.8 ± 11.4 years with a male:female sex ratio of 1.5. The most prevalent risk factors were hepatitis C, hepatitis B, and metabolic pathologies (type 2 diabetes and obesity). The mean BMI was 25.6 ± 4.7 at tumor diagnosis. A strong duality of risk factors and tumor presentation between male and female patients was apparent. Women tended to be older (mean 65.4 vs. 62.7 years, p = 0.039) and either seropositive for anti-HCV (60.0 vs. 41.6%, p = 0.0018) resulting primarily from tattoos and/or scarification (47.2 vs. 25.7%, p = 1.0 × 10<sup>-4</sup>) or more often affected by metabolic disorders (mean BMI 26.1 ± 0.7 vs. 25.1 ± 0.5, p = 0.0248) commonly associated with personal antecedents of cholecystectomy (21.2 vs. 5.8%, p = 4.4 × 10<sup>-5</sup>). By contrast, men were younger, poorer survivors (mean 9.3 vs. 13.3 months, p = 0.005), more frequently HBsAg carriers (27.8 vs. 10.5%, p = 4.8 × 10<sup>-5</sup>), and more exposed to lifestyle risk factors such as smoking (39.4 vs. 3.0%, p = 3.9 × 10<sup>-16</sup>) or alcohol use (19.1 vs. 0.7%, 1.5 × 10<sup>-8</sup>). Finally, geographic disparities throughout Algeria were reminiscent of the situation of chronic hepatitis C in the country. A significant excess of cases originated from the region of Batna, Eastern Algeria, already known for its high rate of hepatitis C. Our results suggest that due to culture or sex-dependent biological differences, the tumor process affecting the liver is drastically different between sexes in Algeria.
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Affiliation(s)
- Yazid Chikhi
- Department of Internal medicine and Gastroenterology, EPH Bologhine, Algiers, Algeria
| | - Salima Cheraitia
- Department of Internal medicine and Gastroenterology, EPH Bologhine, Algiers, Algeria
| | - Rachid Ould Gougam
- Department of Internal medicine and Gastroenterology, EPH Bologhine, Algiers, Algeria
| | - Fadila Lounes
- Department of Internal medicine and Gastroenterology, EPH Bologhine, Algiers, Algeria
| | - Chahrazed Zemmouchi
- Department of Internal medicine and Gastroenterology, EPH Bologhine, Algiers, Algeria
| | - Nassila Belal
- Department of Radiology, Hôpital Central de l'Armée, Ain Naadja, Algiers, Algeria
| | | | | | - Aicha Bensalem
- Laboratory of Virology, Institut Pasteur d'Algérie, Sidi Ferruch, Algiers, Algeria
| | - Saadi Berkane
- Department of Gastroenterology, CHU Mustapha, Algiers, Algeria
| | - Hocine Asselah
- Department of Internal medicine and Gastroenterology, EPH Bologhine, Algiers, Algeria
| | - Pascal Pineau
- Unité "Organisation nucléaire et oncogenèse", INSERM U993, Institut Pasteur, Paris, France
| | - Mustapha Lahcene
- Department of Internal medicine and Gastroenterology, EPH Bologhine, Algiers, Algeria
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Abruzzi A, Fried B, Alikhan SB. Coinfection of Schistosoma Species with Hepatitis B or Hepatitis C Viruses. ADVANCES IN PARASITOLOGY 2016; 91:111-231. [PMID: 27015949 DOI: 10.1016/bs.apar.2015.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although a considerable number of studies have been undertaken to date, it is still controversial as to whether or not coinfection with schistosomiasis increases the susceptibility to or progression from Hepatitis B virus (HBV) or Hepatitis C virus (HCV) infection. This review is a closer examination of the key studies conducted on human populations on clinical factors that were published in English between 1975 and January 2015. Our review is mainly based on tables containing the salient information, which are arranged first by study population, country of study and publication date. We provide further explanation, clarification and discussion in the text. As such, it includes both studies that have been conducted on general populations who are largely asymptomatic for clinical disease (Table 3), as well as those focussing on special populations, which are usually comprised of clinical patients. These special populations have been presented as follows: subjects with chronic liver disease or related conditions such as cirrhosis, Table 4; subjects with primary liver cancer, Table 5; subjects with schistosomiasis, Table 6; subjects with acute or chronic hepatitis resulting from HBV, Table 7 and, subjects with HCV, Table 8. We have presented studies that compared two mono-infected groups with one that is coinfected separately in Table 9, as these offer us the best basis from which to evaluate if any synergistic effects accompany coinfection. A number of factors contributed to the results reported in our tables. These included, but are not limited to: subject selection (i.e. asymptomatic cases typically drawn from the general population vs subjects presenting to a hospital or clinic with clinical disease); study design, which directly impacts our ability to infer causality (i.e. case series, cross-sectional, case-control, cohort study); use and choice of control population (i.e. apparently healthy subjects vs other hospital patients vs none); sample size, which directly impacts statistical power and can result in a Type II error; geographic area, which may reflect differences in population genetics, public health history, environmental differences or any number of other important factors (i.e. Egypt, Brazil, China); method of testing for schistosomal infections (i.e. stool vs antibody test); method of testing to determine if advanced schistosomal disease was present (i.e. ultrasound, liver biopsy vs none); method of serological testing for HBV (i.e. use of HBsAg alone or with other markers or DNA testing); method of serological testing for HCV (i.e. use of anti-HCV alone or with RNA testing) and, year of the study, which reflects among other things, technological improvements between tests as well as possible changes in the frequency of exposure in the populations under study (i.e. use of parenteral antischistosomal therapy vs the oral antischistosomal medication). Despite all these differences, throughout this review we have observed general patterns that seem largely consistent with one another. Studies conducted on general, largely asymptomatic populations tend to support the view that having one of the diseases in question (i.e. schistosomiasis) does not necessarily predispose one to becoming coinfected with another (i.e. HBV or HCV). Rather, the probability of becoming coinfected seems most closely associated with modes of transmission for either HBV or HCV in schistosome-endemic areas, such as the past use of parenteral antischistosomal therapy or frequent blood transfusion. Once coinfected, however, the clinical course of illness for those with Schistosoma-HBV or Schistosoma-HCV infections are typically much more severe than for mono-infected subjects. The strongest evidence for this was found in the half-dozen or so prospective cohort studies that systematically monitored disease progression in their subjects. With respect to HBV infection, coinfection with Schistosoma prolonged the carriage state and more often resulted in chronic hepatitis with greater cirrhosis as well as higher mortality. Much of the same was also observed with respect to HCV, where coinfection with Schistosoma was associated with a reduced ability to spontaneously resolve the viral infection and more often resulted in rapid fibrosis as well as higher mortality. Furthermore, two of these studies which were fully comparative in nature, support the supposition that there is a synergistic association between Schistosoma-HCV for both liver fibrosis and mortality. Immunological studies, all conducted on HCV, also generally seem to support this. The results of our research argue for greater primary prevention for both HBV and HCV in Schistosoma-endemic populations. Although no vaccine currently exists for HCV as it does for HBV, additional steps can still be taken to reduce transmission in high-risk populations. Greater use of the HBV vaccine is particularly advisable. Finally, additional observational, longitudinal studies conducted on human populations that are fully comparative in nature could help answer some of the remaining questions on both Schistosoma-HBV as well as Schistosoma-HCV coinfections. Some of these include the role of active versus past schistosomal infections, the role of genetic variants, as well as the effect of coinfection on treatment. Future studies should make a particular effort to use a sufficient sample size to ensure adequate statistical power, which was not often properly considered in many of the studies we reviewed for this paper.
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Affiliation(s)
- Amy Abruzzi
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
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Abdelwahab SF, Zakaria Z, Sobhy M, Hamdy S, Mahmoud MA, Mikhail N, Allam WR, Rewisha E, Waked I. Differential distribution of IL28B.rs12979860 single-nucleotide polymorphism among Egyptian healthcare workers with and without a hepatitis C virus-specific cellular immune response. Arch Virol 2015; 160:1741-50. [PMID: 25971683 DOI: 10.1007/s00705-015-2446-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/30/2015] [Indexed: 02/08/2023]
Abstract
The CC genotype of the interleukin (IL)-28B.rs12979860 gene has been associated with spontaneous hepatitis C virus (HCV) clearance and treatment response. The distribution and correlation of an IL28B.rs12979860 single-nucleotide polymorphism (SNP) with HCV-specific cell-mediated immune (CMI) responses among Egyptian healthcare workers (HCWs) is not known. We determined this relationship in 402 HCWs who serve a patient cohort with ~85% HCV prevalence. We enrolled 402 HCWs in four groups: group 1 (n = 258), seronegative aviremic subjects; group 2 (n = 25), seronegative viremic subjects; group 3 (n = 41), subjects with spontaneously resolved HCV infection; and group 4 (n = 78), chronic HCV patients. All subjects were tested for an HCV-specific CMI response using an ex-vivo interferon-gamma (IFNγ) ELISpot assay with nine HCV genotype-4a overlapping 15-mer peptide pools corresponding to all of the HCV proteins. All subjects were tested for IL28B.rs12979860 SNP by real-time PCR. An HCV-specific CMI was demonstrated in ~27% of the seronegative aviremic HCWs (group 1), suggesting clearance of infection after low-level exposure to HCV. The frequency of IL28B.rs12979860 C allele homozygosity in the four groups was 49%, 48%, 49%, and 23%, while that of the T allele was 14%, 16%, 12 and 19%, respectively, suggesting differential distributions among subjects with different HCV status. As reported, IL28B.rs12979860 predicted the outcome of HCV infection (p < 0.05), but we did not find any relationship between the IL28B genotypes and the outcome of HCV-specific CMI responses in the four groups (p > 0.05). The data show differential IL28B.rs12979860 genotype distribution among Egyptian HCWs with different HCV status and could not predict the outcome of HCV-specific CMI responses.
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Affiliation(s)
- Sayed F Abdelwahab
- Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, 61511, Egypt,
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Mohamoud YA, Miller FD, Abu-Raddad LJ. Potential for human immunodeficiency virus parenteral transmission in the Middle East and North Africa: An analysis using hepatitis C virus as a proxy biomarker. World J Gastroenterol 2014; 20:12734-12752. [PMID: 25278675 PMCID: PMC4177460 DOI: 10.3748/wjg.v20.i36.12734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/20/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The Middle East and North Africa (MENA) region has endured several major events of infection parenteral transmission. Recent work has established the utility of using hepatitis C virus (HCV) as a proxy biomarker for assessing the epidemic potential for human immunodeficiency virus (HIV) parenteral transmission. In this review, we use data on the prevalence of HCV infection antibody (seroprevalence) among general population and high risk population groups to assess the potential for HIV parenteral transmission in MENA. Relatively low prevalence of HCV infection in the general population groups was reported in most MENA countries indicating that parenteral HIV transmission at endemic levels does not appear to be a cause for concern. Nonetheless, there could be opportunities for localized HIV outbreaks and transmission of other blood-borne infections in some settings such as healthcare facilities. Though there have been steady improvements in safety measures related to parenteral modes of transmission in the region, these improvements have not been uniform across all countries. More precautions, including infection control training programs, surveillance systems for nosocomial infections and wider coverage and evaluation of hepatitis B virus immunization programs need to be implemented to avoid the unnecessary spread of HIV, HCV, and other blood-borne pathogens along the parenteral modes of transmission.
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Correlations of hematological parameters with bone marrow findings in chronic lymphoproliferative disorders associated with hepatitis viruses. J Med Life 2013; 6:464-71. [PMID: 24868264 PMCID: PMC4034312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/25/2013] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Hepatitis B and C viruses' infections are often associated with hematological disorders in evolution, suggesting that these viruses have a tropism for peripheral blood and/or bone marrow cells. AIM To analyze the hematological parameters and bone marrow findings in a group of patients diagnosed with chronic lymphoproliferative disorders (CLD) and hepatitis viruses B, C, D infections, which were included in the research grant (acronym LIMFO-VIR) between December 2007 and May 2010 in the Hematology Department of the Emergency University Hospital of Bucharest. METHODS AND RESULTS Patients were diagnosed by using immunopathology according to the WHO criteria. The analyzed group included 42 patients (both sexes), with the mean age of 60,35 years. The most frequent hematologic disease was non-Hodgkin's lymphoma 30/42 (71,42%), followed by chronic lymphocytic leukemia (16,66%) and Hodgkin's lymphoma (7,14%). Hepatitis viruses were distributed: 17/42 (40,47%) patients with HBV, 22/42 (52,38%) with HCV and 3/42 (7,14%) had a double/triple association of viruses. Most of the patients had an indolent type of disease - 27/42 (64,28%), whereas 15/42 (35,71%) had an aggressive one, pattern found both in the HBV and HCV infected groups. An abnormal bone marrow result was revealed in 32/42 (76,19%) patients, 19 (59,37%) of them being HCV infected. Myelodysplasia was found in 6/42(14,28%) patients, the majority being HCV infected, all having an indolent form of CLD. The antiviral therapy did not influence the hematological parameters (no significant differences were found between the groups with/without an antiviral therapy). DISCUSSIONS Patients with hepatitis virus infections may associate neutropenia and thrombocytopenia; the mechanisms are thought to involve hypersplenism, autoimmune processes and antiviral therapy. We excluded the influence of chemotherapy, as the study was performed before the treatment. In our group, patients whether HBV or HCV infected, presented an isolated cytopenia. The abnormal bone marrow cellularity (increased or decreased) and dysplasia were found especially in the HCV group. There are studies showing no association between myelodysplasia and hepatitis viruses; others found a strong relation of these. One of the mechanisms of myelodysplasia could be a dysregulation of the immune system. Conclusions. Bone marrow/peripheral blood features correlate with the type of viral infection and HCV is more prone to develop additional hematological changes than HBV. The degree of bone marrow involvement by CLDs influences these features. We considered mandatory to perform a bone marrow analysis at the diagnosis of CLDs to stage and to establish if other bone marrow changes were present, a crucial aspect for therapy and outcome of the disease. The association between the hepatitis viruses - myelodysplasia- autoimmunity seems to have a role in the lymphoproliferative disorders etiology. ABBREVIATIONS CLD - chronic lymphoproliferative disorders; NHL- non-Hodgkin's lymphoma, CLL- chronic lymphocytic leukemia, HL- Hodgkin's lymphoma, MDS - myelodysplastic syndrome, AML - acute myeloid leukemia.
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Hatzakis A, Van Damme P, Alcorn K, Gore C, Benazzouz M, Berkane S, Buti M, Carballo M, Cortes Martins H, Deuffic-Burban S, Dominguez A, Donoghoe M, Elzouki AN, Ben-Alaya Bouafif N, Esmat G, Esteban R, Fabri M, Fenton K, Goldberg D, Goulis I, Hadjichristodoulou C, Hatzigeorgiou T, Hamouda O, Hasurdjiev S, Hughes S, Kautz A, Malik M, Manolakopoulos S, Matičič M, Papatheodoridis G, Peck R, Peterle A, Potamitis G, Prati D, Roudot-Thoraval F, Reic T, Sharara A, Shennak M, Shiha G, Shouval D, Sočan M, Thomas H, Thursz M, Tosti M, Trépo C, Vince A, Vounou E, Wiessing L, Manns M, Manns M. The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference. J Viral Hepat 2013; 20 Suppl 2:1-20. [PMID: 23827008 DOI: 10.1111/jvh.12120] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research.
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Affiliation(s)
- A Hatzakis
- National Retrovirus Reference Center, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
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Mohamoud YA, Mumtaz GR, Riome S, Miller D, Abu-Raddad LJ. The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis. BMC Infect Dis 2013; 13:288. [PMID: 23799878 PMCID: PMC3702438 DOI: 10.1186/1471-2334-13-288] [Citation(s) in RCA: 236] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 06/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. Our study's objective was to delineate the evidence on the epidemiology of HCV infection among the different population groups in Egypt, and to draw analytical inferences about the nature of HCV transmission in this country. METHODS We conducted a systematic review of all data on HCV prevalence and incidence in Egypt following PRISMA guidelines. The main sources of data included PubMed and Embase databases. We also used a multivariate regression model to infer the temporal trend of HCV prevalence among the general population and high risk population in Egypt. RESULTS We identified 150 relevant records, four of which were incidence studies. HCV incidence ranged from 0.8 to 6.8 per 1,000 person-years. Overall, HCV prevalence among pregnant women ranged between 5-15%, among blood donors between 5-25%, and among other general population groups between 0-40%. HCV prevalence among multi-transfused patients ranged between 10-55%, among dialysis patients between 50-90%, and among other high risk populations between 10% and 85%. HCV prevalence varied widely among other clinical populations and populations at intermediate risk. Risk factors appear to be parenteral anti-schistosomal therapy, injections, transfusions, and surgical procedures, among others. Results of our time trend analysis suggest that there is no evidence of a statistically significant decline in HCV prevalence over time in both the general population (p-value: 0.215) and high risk population (p-value: 0.426). CONCLUSIONS Egypt is confronted with an HCV disease burden of historical proportions that distinguishes this nation from others. A massive HCV epidemic at the national level must have occurred with substantial transmission still ongoing today. HCV prevention in Egypt must become a national priority. Policymakers, and public health and medical care stakeholders need to introduce and implement further prevention measures targeting the routes of HCV transmission.
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Affiliation(s)
- Yousra A Mohamoud
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Ghina R Mumtaz
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Suzanne Riome
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - DeWolfe Miller
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, Hawaii
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Public Health, Weill Cornell Medical College, Cornell University, New York, New York, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Abdelwahab SF, Hashem M, Galal I, Sobhy M, Abdel-Ghaffar TS, Galal G, Mikhail N, El-Kamary SS, Waked I, Strickland GT. Incidence of hepatitis C virus infection among Egyptian healthcare workers at high risk of infection. J Clin Virol 2013; 57:24-8. [PMID: 23375237 DOI: 10.1016/j.jcv.2013.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 12/28/2012] [Accepted: 01/03/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a global health threat with Egypt having the highest worldwide prevalence. Evaluation of the efficacy of a preventive HCV vaccine, such as those currently in Phase I/II trials, requires a cohort with a high-risk exposure to HCV. OBJECTIVE To identify a reliable cohort for evaluating preventive HCV vaccines, we studied HCV incidence among HCW in a hospital where almost 85% of patients are HCV-infected. STUDY DESIGN Of 717 HCW negative for HCV-antibodies (anti-HCV) at baseline, 651 were followed up and tested for seroconversion twice annually for an average of 504 ± 154 days. Those reporting a needle-stick injury were additionally tested for both HCV antibodies and RNA monthly for a total of four months. RESULTS Two subjects (0.31%) had anti-HCV and HCV-RNA seroconversion with an overall incidence of 2.04/1000 person-years and a 4.8% incidence among the 21 subjects who reported a needle-stick injury. Two additional subjects had viremia without detectable anti-HCV. Two of the four subjects were among 21 with reported needle-stick injuries (9.5%) and another had surgery. All four were nurses providing direct patient care. CONCLUSIONS Our results show that both transient and persistent viremia were detectable in this high-risk cohort of HCW and suggest that absence of anti-HCV in two of the subjects may be due to low-dose viral exposures. These data indicate that HCV infections acquired from documented injuries during direct patient care are frequent in Egypt and can guide selection of eligible HCW suitable for preventive HCV vaccine trials.
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Affiliation(s)
- Sayed F Abdelwahab
- Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt.
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Prevalence and Risk Factors of Hepatitis B and Hepatitis C Virus Infections among Patients with Chronic Liver Diseases in Public Hospitals in Addis Ababa, Ethiopia. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/563821] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and Aims. Hepatitis B and hepatitis C viruses are major public health problems worldwide. The aim of this study was to determine the prevalence and risk factors of hepatitis B and C virus infections in patients with chronic liver diseases in three public hospitals in Addis Ababa City, Ethiopia.
Methods. The study was conducted on 120 clinically diagnosed chronic liver disease patients. Possible associated factors with infections by the viruses were collected from patient using questionnaire. Serum was screened for the presence of hepatitis B surface antigen and antihepatitis C virus antibodies using qualitative immunochromatographic method.
Results. Hepatitis B surface antigen was detected in 43 (35.8%) and anti-HCV antibody 27 (22.5%) patients clinically diagnosed to have chronic liver diseases. Hepatitis B virus infection was higher in males 29/76 (38.2%) compared to 14/44 (31.8%) females, while antihepatitis C virus antibody was higher in females 13/44 (29.5%) compared to 14/76 (18.4%) males. Of the study participants, 3 (2.5%) had dual hepatitis B and C virus coinfection.
Conclusion. The prevalence of hepatitis B surface antigen and anti-HCV antibody was high in patients below 50 years of age. Dental extraction procedure at health facility was associated with hepatitis C virus infection (OR, 2.95; 95% CI, 1.21–7.17, ).
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Deghady A, Abdou A, EL-Neanaey WA, Diab I. Association of Genetic Polymorphism −670A>G in the Fas Gene and Serum Markers AST Platelet Ratio Index, AST/ALT with Significant Fibrosis and Cirrhosis in Chronic Hepatitis C. Genet Test Mol Biomarkers 2012; 16:531-5. [DOI: 10.1089/gtmb.2011.0098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Akram Deghady
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Alaa Abdou
- Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Wafaa Ahmed EL-Neanaey
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman Diab
- Department of Biochemistry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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13
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Abdelwahab SF, Zakaria Z, Sobhy M, Rewisha E, Mahmoud MA, Amer MA, Del Sorbo M, Capone S, Nicosia A, Folgori A, Hashem M, El-Kamary SS. Hepatitis C virus-multispecific T-cell responses without viremia or seroconversion among Egyptian health care workers at high risk of infection. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:780-6. [PMID: 22441392 PMCID: PMC3346335 DOI: 10.1128/cvi.00050-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV)-specific cell-mediated immunity (CMI) has been reported among exposed individuals without viremia or seroconversion. Limited data are available regarding CMI among at-risk, seronegative, aviremic Egyptian health care workers (HCW), where HCV genotype 4 predominates. We investigated CMI responses among HCW at the National Liver Institute, where over 85% of the patients are HCV infected. We quantified HCV-specific CMI in 52 seronegative aviremic Egyptian HCW using a gamma interferon (IFN-γ) enzyme-linked immunospot assay in response to 7 HCV genotype 4a overlapping 15-mer peptide pools covering most of the viral genome. A positive HCV-specific IFN-γ response was detected in 29 of 52 HCW (55.8%), where 21 (40.4%) had a positive response for two to seven HCV pools and 8 (15.4%) responded to only one pool. The average numbers of IFN-γ total spot-forming cells (SFC) per million peripheral blood mononuclear cells (PBMC) (± standard error of the mean [SEM]) in the 29 responding and 23 nonresponding HCW were 842 ± 141 and 64 ± 15, respectively (P < 0.001). Flow cytometry indicated that both CD4(+) and CD4(-) T cells produced IFN-γ. In summary, more than half of Egyptian HCW demonstrated strong HCV multispecific CMI without viremia or seroconversion, suggesting possible clearance of low HCV exposure(s). These data suggest that detecting anti-HCV and viremia to determine past exposure to HCV can lead to an underestimation of the true disease exposure and that CMI response may contribute to the low degree of chronic HCV infection in these HCW. These findings could have strong implications for planning vaccine studies among populations with a high HCV exposure rate. Further studies are needed to determine whether these responses are protective.
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Affiliation(s)
- Sayed F Abdelwahab
- Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt.
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14
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Shemis MA, El-Abd DM, Ramadan DI, El-Sayed MI, Guirgis BS, Saber MA, El-Said Azzazy HM. Evaluation of multiplex nested polymerase chain reaction for routine hepatitis C virus genotyping in egyptian patients. HEPATITIS MONTHLY 2012; 12:265-70. [PMID: 22690234 PMCID: PMC3360936 DOI: 10.5812/hepatmon.830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/24/2011] [Accepted: 01/25/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND At least six HCV (hepatitis C virus) genotypes are unequally distributed worldwide. HCV genotyping guides the selection of treatment regimens and provides important epidemiological markers that enable the outbreak source to be traced and the spread of disease to be controlled. In Egypt, there is an increasing need for cost-effective, fast, and easily performable HCV genotyping assays.Recently, a multiplex PCR assay was developed to determine HCV genotypes. It employs genotype-specific primers, based on sequences of the entire core region and part of the 5'UTR of the genome. OBJECTIVES In this study, we compared a simple, new, modified multiplex PCR system for HCV genotyping with a commercially available line probe assay (INNO-LiPA) that is based on reverse hybridization. PATIENTS AND METHODS Serum samples from chronic HCV Egyptian patients (n = 73) were genotyped using the modified multiplex PCR assay, and genotypes were verified using the INNO-LiPA HCV II assay. RESULTS The modified multiplex PCR method was able to type HCV-4 in 65 of 70 typeable samples (92.86%) and had 100% concordance with the INNO-LiPA assay. CONCLUSIONS Genotype 4 was the most prevalent genotype in our study. Based on our results, the modified multiplex nested PCR assay is a sensitive and inexpensive alternative for HCV genotyping and can be used in routine diagnostic laboratories. INNO-LiPA may be useful as a second-line assay for genotyping samples that are indeterminate by multiplex PCR. This approach will effect better treatment optimization and a reduction of the spread of HCV.
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Affiliation(s)
| | - Dina Mohamed El-Abd
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Ibrahim Ramadan
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Corresponding author: Dalia Ibrahim Ramadan, 21A, street 275, New Maadi, 11435, Cairo, Egypt. Tel.: +2-226771176, Fax: +2-22707367, E-mail:
| | | | - Bassem Shenoda Guirgis
- Yousef Jameel Science and Technology Research Center, the American University in Cairo, Cairo, Egypt
| | - Mohamed Ali Saber
- Department of Biochemistry, Theodor Bilharz Research Institute, Giza, Egypt
| | - Hassan Mohamed El-Said Azzazy
- Yousef Jameel Science and Technology Research Center, the American University in Cairo, Cairo, Egypt
- Department of Chemistry, the American University in Cairo, Cairo, Egypt
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15
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Evaluation of Multiplex Nested Polymerase Chain Reaction for Routine Hepatitis C Virus Genotyping in Egyptian Patients. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hepatmon.6012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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16
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Estrogen-related MxA transcriptional variation in hepatitis C virus-infected patients. Transl Res 2012; 159:190-6. [PMID: 22340769 DOI: 10.1016/j.trsl.2011.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/04/2011] [Accepted: 08/04/2011] [Indexed: 12/29/2022]
Abstract
Sex has been reported to influence the rates of viral clearance in hepatitis C virus (HCV)-infected patients. However, little is known regarding the influence of sex on the host genetic response to HCV, which is mediated by the expression of interferon (IFN)-stimulated genes (ISGs) after the activation of janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway by IFN. Thus, we investigated gender differences in MxA genetic profile, which is a downstream reliable marker for JAK/STAT pathway activation. In all, 40 untreated HCV-infected patients were subclassified into premenopausal, postmenopausal, and male patients. The peripheral blood mononuclear cells (PBMCs) from premenopausal women showed the highest MxA gene expression compared to both postmenopausal females and males before and after IFN stimulation. The prestimulation of PBMCs with 17beta-estradiol prior to IFN treatment resulted in a decrease of MxA expression in all groups of patients. That was confirmed by the reversal of this effect using estrogen antagonist ICI182/780. This study demonstrates for the first time the presence of gender variations in the genetic response to chronic HCV infection and to interferon treatment. It also clarifies that estrogen is not the key player in enhancing the JAK/STAT pathway.
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17
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Abdelwahab S, Rewisha E, Hashem M, Sobhy M, Galal I, Allam WR, Mikhail N, Galal G, El-Tabbakh M, El-Kamary SS, Waked I, Strickland GT. Risk factors for hepatitis C virus infection among Egyptian healthcare workers in a national liver diseases referral centre. Trans R Soc Trop Med Hyg 2012; 106:98-103. [PMID: 22197011 DOI: 10.1016/j.trstmh.2011.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 10/04/2011] [Accepted: 10/04/2011] [Indexed: 02/08/2023] Open
Abstract
Little is known about the prevalence of hepatitis C virus (HCV) among healthcare workers (HCW) in Egypt, where the highest worldwide prevalence of HCV exists. The prevalence of HCV, hepatitis B virus and Schistosoma mansoni antibodies was examined in 842 HCWs at the National Liver Institute in the Nile Delta, where >85% of patients are HCV antibody-positive. The mean age of HCWs was 31.5 years and they reported an average of 0.6±1.2 needlesticks/HCW/year. The prevalence of anti-HCV, hepatitis B surface antigen (HBsAg) and co-infection was 16.6%, 1.5% and 0.2%, respectively. HCV-RNA was present in 72.1% of anti-HCV-positive HCWs, and all but one subject were infected with HCV genotype 4. Schistosoma mansoni antibodies were present in 35.1%. The anti-HCV rate increased sharply with age and employment duration, but not among those with needlestick history. After adjusting for other risk factors, the anti-HCV rate was higher among older HCWs [P<0.001; risk ratio (RR) = 1.086, 95% CI 1.063-1.11], males (P=0.002; RR=1.911, 95% CI 1.266-2.885) and those with rural residence (P<0.001; RR=2.876, 95% CI 1.830-4.52). Occupation (P=0.133), duration of employment (P=0.272) or schistosomal antibody positivity (P=0.152) were not significant risk factors for anti-HCV positivity. In conclusion, although one in six HCWs had been infected with HCV, the infections were more likely to be community-acquired and not occupationally related.
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Affiliation(s)
- Sayed Abdelwahab
- Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt.
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18
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Lohse AW, Wiegard C. Diagnostic criteria for autoimmune hepatitis. Best Pract Res Clin Gastroenterol 2011; 25:665-71. [PMID: 22117633 DOI: 10.1016/j.bpg.2011.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/25/2011] [Indexed: 01/31/2023]
Abstract
The clinical spectrum of autoimmune hepatitis is very wide. In addition, autoimmune hepatitis can present in any age group. Diagnosis is usually made by a combination of clinical, laboratory and histological features. Diagnostic scores can help both in the daily diagnostic work-up of patients, and in allowing comparability of clinical scientific studies. However, all diagnostic scores have limitations in individual cases, which are discussed in this review.
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Affiliation(s)
- Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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19
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Abstract
Hepatitis C (HCV) is the disease that has affected around 200 million people globally. HCV is a life threatening human pathogen, not only because of its high prevalence and worldwide burden but also because of the potentially serious complications of persistent HCV infection. Chronicity of the disease leads to cirrhosis, hepatocellular carcinoma and end-stage liver disease. HCV positive hepatocytes vary between less than 5% and up to 100%, indicating the high rate of replication of viral RNA. HCV has a very high mutational rate that enables it to escape the immune system. Viral diversity has two levels; the genotypes and Quasiaspecies. Major HCV genotypes constitute genotype 1, 2, 3, 4, 5 and 6 while more than 50 subtypes are known. All HCV genotypes have their particular patterns of geographical distribution and a slight drift in viral population has been observed in some parts of the globe.
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Affiliation(s)
- Nazish Bostan
- Department of Biological Sciences, Quaid-i-Azam University, Islamabad-45320, Pakistan
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20
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Strickland GT, El-Kamary SS, Klenerman P, Nicosia A. Hepatitis C vaccine: supply and demand. THE LANCET. INFECTIOUS DISEASES 2008; 8:379-86. [DOI: 10.1016/s1473-3099(08)70126-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Esmat G, Metwally M, Zalata KR, Gadalla S, Abdel-Hamid M, Abouzied A, Shaheen AA, El-Raziky M, Khatab H, El-Kafrawy S, Mikhail N, Magder LS, Afdhal NH, Strickland GT. Evaluation of serum biomarkers of fibrosis and injury in Egyptian patients with chronic hepatitis C. J Hepatol 2007; 46:620-7. [PMID: 17316875 DOI: 10.1016/j.jhep.2006.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 12/05/2006] [Accepted: 12/13/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS We evaluated whether surrogate serum biomarkers for liver injury are comparable to liver biopsy in Egyptian patients with hepatitis C virus (HCV) infection. SUBJECTS Two hundred and twenty Egyptian patients, 91% infected with genotype-4 HCV, undergoing liver biopsy during evaluation for interferon/ribavirin therapy. METHODS Liver biopsy scored by the Ishak method was compared to biochemical tests, platelet count and two fibrosis biomarkers: hyaluronic acid (HA) and YKL-40. Univariate and logistic regression analyses determined independent predictors of fibrotic, inflammatory, and fatty changes. Biomarkers were evaluated for ability to differentiate between severe fibrosis/cirrhosis and no/mild fibrosis. RESULTS Although increasing age, HA, YKL-40, AST, reduced platelet count, and AST and HA/platelet count ratios were associated with fibrosis by univariate analysis, the other variables were not significant after controlling for HA (p=0.0001) and age (p=0.004). Although age and some biomarkers were associated with inflammation, none remained significant after controlling for fibrosis. YKL-40 (p=0.04) and aspartate aminotransferase (p=0.05) remained associated with steatosis after controlling for fibrosis. CONCLUSIONS In Egyptians with chronic HCV, young patients with low levels of HA are at very low risk of fibrosis. This can limit the number of liver biopsies to those whose clinical findings conflict with the biomarker results.
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Affiliation(s)
- Gamal Esmat
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
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22
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The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45:529-38. [PMID: 16879891 DOI: 10.1016/j.jhep.2006.05.013] [Citation(s) in RCA: 1768] [Impact Index Per Article: 98.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 05/03/2006] [Accepted: 05/16/2006] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS End-stage liver disease accounts for one in forty deaths worldwide. Chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are well-recognized risk factors for cirrhosis and liver cancer, but estimates of their contributions to worldwide disease burden have been lacking. METHODS The prevalence of serologic markers of HBV and HCV infections among patients diagnosed with cirrhosis or hepatocellular carcinoma (HCC) was obtained from representative samples of published reports. Attributable fractions of cirrhosis and HCC due to these infections were estimated for 11 WHO-based regions. RESULTS Globally, 57% of cirrhosis was attributable to either HBV (30%) or HCV (27%) and 78% of HCC was attributable to HBV (53%) or HCV (25%). Regionally, these infections usually accounted for >50% of HCC and cirrhosis. Applied to 2002 worldwide mortality estimates, these fractions represent 929,000 deaths due to chronic HBV and HCV infections, including 446,000 cirrhosis deaths (HBV: n=235,000; HCV: n=211,000) and 483,000 liver cancer deaths (HBV: n=328,000; HCV: n=155,000). CONCLUSIONS HBV and HCV infections account for the majority of cirrhosis and primary liver cancer throughout most of the world, highlighting the need for programs to prevent new infections and provide medical management and treatment for those already infected.
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23
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El-Awady MK, Youssef SS, Omran MH, Tabll AA, El Garf WT, Salem AM. Soluble egg antigen of Schistosoma Haematobium induces HCV replication in PBMC from patients with chronic HCV infection. BMC Infect Dis 2006. [PMID: 16756654 DOI: 10.1186/1471-2334-6-91.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was conducted to examine, in vitro , the effect of soluble egg antigen (SEA) of S. haematobium on intracellular HCV RNA load in peripheral mononuclear cells (PBMC) as well as on cell proliferation in patients with chronic HCV infection. METHODS PBMC from 26 patients with chronic HCV infection were cultured for 72 hours in presence and absence of 50 mug SEA/ml medium. Intracellular HCV RNA quantification of plus and minus strands was assessed before and after stimulation. PBMC from five healthy subjects were cultured for 7 days, flow cytometric analysis of DNA content was used to assess the mitogenic effect of SEA on PBMC proliferation compared to phytoheamaglutinine (PHA). RESULTS Quantification of the intracellular viral load showed increased copy number/cell of both or either viral strands after induction with SEA in 18 of 26 patients (69.2%) thus indicating stimulation of viral replication. Flow cytometric analysis showed that mean +/- S.D. of percent values of cell proliferation was induced from 3.2 +/- 1.5% in un-stimulated cells to 16.7 +/- 2.5 % and 16.84 +/- 1.7 % in cells stimulated with PHA and SEA respectively. CONCLUSION the present study supports earlier reports on SEA proliferative activity on PBMC and provides a strong evidence that the higher morbidity observed in patients co-infected with schistosomiasis and HCV is related, at least in part, to direct stimulation of viral replication by SEA.
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Affiliation(s)
- Mostafa K El-Awady
- Department of Biomedical Technology, National Research Center, Dokki, Cairo, Egypt.
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24
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El-Awady MK, Youssef SS, Omran MH, Tabll AA, El Garf WT, Salem AM. Soluble egg antigen of Schistosoma Haematobium induces HCV replication in PBMC from patients with chronic HCV infection. BMC Infect Dis 2006; 6:91. [PMID: 16756654 PMCID: PMC1550722 DOI: 10.1186/1471-2334-6-91] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 06/06/2006] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study was conducted to examine, in vitro , the effect of soluble egg antigen (SEA) of S. haematobium on intracellular HCV RNA load in peripheral mononuclear cells (PBMC) as well as on cell proliferation in patients with chronic HCV infection. METHODS PBMC from 26 patients with chronic HCV infection were cultured for 72 hours in presence and absence of 50 mug SEA/ml medium. Intracellular HCV RNA quantification of plus and minus strands was assessed before and after stimulation. PBMC from five healthy subjects were cultured for 7 days, flow cytometric analysis of DNA content was used to assess the mitogenic effect of SEA on PBMC proliferation compared to phytoheamaglutinine (PHA). RESULTS Quantification of the intracellular viral load showed increased copy number/cell of both or either viral strands after induction with SEA in 18 of 26 patients (69.2%) thus indicating stimulation of viral replication. Flow cytometric analysis showed that mean +/- S.D. of percent values of cell proliferation was induced from 3.2 +/- 1.5% in un-stimulated cells to 16.7 +/- 2.5 % and 16.84 +/- 1.7 % in cells stimulated with PHA and SEA respectively. CONCLUSION the present study supports earlier reports on SEA proliferative activity on PBMC and provides a strong evidence that the higher morbidity observed in patients co-infected with schistosomiasis and HCV is related, at least in part, to direct stimulation of viral replication by SEA.
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Affiliation(s)
- Mostafa K El-Awady
- Department of Biomedical Technology, National Research Center,, El tahrir St., Dokki, Cairo, Egypt
| | - Samar S Youssef
- Department of Biomedical Technology, National Research Center,, El tahrir St., Dokki, Cairo, Egypt
| | - Moataza H Omran
- Department of Biomedical Technology, National Research Center,, El tahrir St., Dokki, Cairo, Egypt
| | - Ashraf A Tabll
- Department of Biomedical Technology, National Research Center,, El tahrir St., Dokki, Cairo, Egypt
| | - Wael T El Garf
- Department of Biomedical Technology, National Research Center,, El tahrir St., Dokki, Cairo, Egypt
| | - Ahmed M Salem
- Department of biochemistry, Ain Shams University, El Abassia Sq., Cairo, Egypt
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25
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Strickland GT. Liver disease in Egypt: hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors. Hepatology 2006; 43:915-22. [PMID: 16628669 DOI: 10.1002/hep.21173] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In Egypt, schistosomiasis was traditionally the most important public health problem and infection with Schistosoma mansoni the major cause of liver disease. From the 1950s until the 1980s, the Egyptian Ministry of Health (MOH) undertook large control campaigns using intravenous tartar emetic, the standard treatment for schistosomiasis, as community-wide therapy. This commendable effort to control a major health problem unfortunately established a very large reservoir of hepatitis C virus (HCV) in the country. By the mid-1980s, the effective oral drug, praziquantel, replaced tartar emetic a s treatment f o r schistosomiasis in the entire country. This both reduced schistosomal transmission and disease and interrupted the "occult" HCV epidemic. It was evident when diagnostic serology became available in the 1990s that HCV had replaced schistosomiasis as the predominant cause of chronic liver disease. Epidemiological studies reported a high prevalence and incidence of HCV, particutarly within families in rural areas endemic for schistosomiasis. Clinical studies showed 70% to 90% of patients with chronic hepatitis, cirrhosis, or hepatocellular carcinoma had HCV infections. Co-infections with schistosomiasis caused more severe liver disease than infection with HCV alone. Schistosomiasis was reported to cause an imbalance in HCV-specific T-cell responses leading to increased viral load, a higher probability of HCV chronicity, and more rapid progression of complications in co-infected persons. As complications of HCV usually occur after 20 years of infection, the peak impact of the Egyptian outbreak has not yet occurred. Efforts have been initiated by the Egyptian MOH to prevent new infections and complications of HCV in the estimated 6 million infected persons.
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Affiliation(s)
- G Thomas Strickland
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
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26
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Nada O, Abdel-Hamid M, Ismail A, El Shabrawy L, Sidhom KFS, El Badawy NMA, Ghazal FAA, El Daly M, El Kafrawy S, Esmat G, Loffredo CA. The role of the tumor necrosis factor (TNF)--Fas L and HCV in the development of hepatocellular carcinoma. J Clin Virol 2006; 34:140-6. [PMID: 16157266 DOI: 10.1016/j.jcv.2005.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Revised: 01/24/2005] [Accepted: 02/09/2005] [Indexed: 11/20/2022]
Abstract
Hepatocellular carcinoma (HCC) is a major public health problem in Egypt due to the high prevalence of hepatitis C viral (HCV) infection. The mechanism by which HCV exerts its carcinogenic effect on the liver is not yet understood. Previous research has suggested that perturbations of the Fas-Fas L tumor necrosis system could result in uncontrolled cancerous cell growth in the liver. This study aims to assess the relationship of Fas ligand (Fas L) to HCC. A total of 28 cases (HCC) and 56 controls (28 cirrhosis and 28 chronic hepatitis) were included in the study. Sera and tissue biopsies were tested for HCV antibody and HCV-RNA. Fas ligand expression in tissue was examined immunohistochemically using a rabbit purified polyclonal antibody. Levels of soluble Fas L were determined in serum by ELISA. The HCC cases were graded as: 17.9% Grade I, 32.1% Grade II, 35.7% Grade III and 14.3% were Grade IV. Among the cases, 81% had evidence of cirrhosis. All the cases and controls were positive for HCV-RNA. Tissue and serum PCR results were identical within the same subjects. Fas ligand cytoplasmic expression was more pronounced in HCC than in cirrhosis, and in cirrhosis more than in chronic hepatitis. This expression was higher with increasing grades of malignancy and in tissues adjacent to the tumor, than in those without nearby tumor. Soluble Fas L levels were higher in cases than in controls, with similar results as that of immunohistochemical expression. These results suggest that HCV and Fas ligand play a key role in hepatocarcinogenesis, consistent with the hypothesis that HCV induces overexpression of Fas ligand in the liver cells, resulting in escape from killing by the immune system cells, with subsequent uncontrolled growth of tissue and the development of malignancy.
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Affiliation(s)
- Ola Nada
- Department of Pathology, Ain Shams University, Cairo, Egypt
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27
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Hoare M, Gelson WTH, Davies SE, Curran M, Alexander GJM. Hepatic and intestinal schistosomiasis after orthotopic liver transplant. Liver Transpl 2005; 11:1603-7. [PMID: 16315308 DOI: 10.1002/lt.20622] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Schistosomiasis affects 200 to 250 million people worldwide. Hepatic schistosomiasis is a well-recognized cause of chronic liver disease and portal hypertension. There are no previous reports of schistosomiasis post liver transplantation. We report on 2 cases of schistosomiasis in liver transplant recipients--a case of gastric schistosomiasis and a case of hepatic schistosomiasis. A discussion of the pathology of schistosomal infection and a rationale for screening potential liver transplant recipients from endemic areas follows.
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Affiliation(s)
- Matthew Hoare
- Department of Hepatology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
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28
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Zekri ARN, Ashour MSED, Hassan A, Alam El-Din HM, El-Shehaby AMR, Abu-Shady MA. Cytokine profile in Egyptian hepatitis C virus genotype-4 in relation to liver disease progression. World J Gastroenterol 2005; 11:6624-30. [PMID: 16425355 PMCID: PMC4355755 DOI: 10.3748/wjg.v11.i42.6624] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To observe the imbalance between T helper cell Th1 and Th2 cytokines in several chronic hepatitis disease at different stages of disease progression.
METHODS: We measured the cytokine levels of Th1 (IL-2 and IL-2R), Th2 (IL-10) and the pro-inflammatory cytokines (IL-6 and IL-6R and TNF and TNF-RI and II) by the ELISA technique in the sera of 33 hepatocellular carcinoma (HCC) patients and 20 chronic liver disease (CLD) patients. In addition, 20 asymptomatic hepatitis C virus carriers and 20 healthy subjects negative for hepatitis C virus(HCV) markers served as controls.
RESULTS: Anti-HCV antibodies were found to be positive in 94% of HCC cases and 75% of CLD cases. On the other hand, HCV viremia was detected using RT-PCR in 67% of HCC cases and 65% of CLD cases. HBsAg was positive in 9% of HCC cases and 30% of CLD cases. Also bilharzial-Ab was positive in 55% of HCC cases, 65% of CLD cases and in 70% of asymptomatic carriers (ASC). HCC patients had significantly higher values of IL-2R, TNF-RII (P<0.001), and TNF-RI (P>0.05), but lower TNFα (P<0.001) and IL-6 (P = 0.032) in comparison to ASC. But, in comparison to non-cancer controls, HCC patients had higher values of IL-2R, IL-6R, TNF-RI and TNF-RII, but lower TNF-α (P<0.001). CLD patients had higher IL-2R, TNF-RI, and TNF-RII (P<0.001) than ASC. But, in comparison to non-cancer controls, CLD patients had higher values of IL-2R, TNF-RI and TNF-RII, but lower TNF-α (P<0.001). IL-10 was higher (though not significantly) in HCC and CLD patients than in symptomatic carriers and non-cancer controls.
CONCLUSION: Liver disease progression from CLD to HCC due to HCV genotype-4 infection is associated with an imbalance between Th1 and Th2 cytokines. IL-2R, TNF-RI, and TNF-RII could be used as potential markers.
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Affiliation(s)
- Abdel-Rahman N Zekri
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Fom El-Khalig, Cairo 11796, Egypt.
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Tavares-Neto J, Prata A, Paraná R, Valente VB, Vitvitski L, Figueiredo JFC. Very low prevalence of hepatitis C virus infection in rural communities of northeastern Brazil with a high prevalence of schistosomiasis mansoni. Rev Soc Bras Med Trop 2005; 38:290-3. [PMID: 16082473 DOI: 10.1590/s0037-86822005000400002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The association of hepatitis C virus infection and the hepatosplenic form of schistosomiasis mansoni has been claimed to result in the concomitant evolution of the two pathologies, with a poor prognosis due to aggravated liver disease. Recently, however, some authors have begun to reject the hypothesis of a higher susceptibility of hepatosplenic schistosomal patients to HCV. The aim of the present transverse study carried out between July and August 1990 was to determine the possible association between SM and HCV markers in residents of Catolândia, Bahia State. Anti-HCV markers were assayed by ELISA-II and RIBA-II in serum samples obtained from 1,228 residents (85.8%). The anti-HCV antibody (ELISA-II) was positive in six (0.5%) individuals, eight (0.6%) cases were inconclusive and 1,214 (98.9%) were negative. However, only in one ELISA-positive serum sample (0.08%) were antibodies confirmed by RIBA-II, while two other samples assayed by RIBA-II were indeterminate. These three patients presented the hepatointestinal form of SM during the follow-up period (1976 to 1996). In conclusion, no association was observed between HCV and SM in the endemic area studied, especially among patients with the hepatosplenic form of the disease.
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Affiliation(s)
- Jose Tavares-Neto
- Faculty of Medicine of Bahia, Federal University of Bahia, R. Marquês de Caravelas 262/101, 40140-210 Salvador, Bahia, Brazil.
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Djebbi A, Mejri S, Thiers V, Triki H. Phylogenetic analysis of hepatitis C virus isolates from Tunisian patients. Eur J Epidemiol 2004; 19:555-62. [PMID: 15330128 DOI: 10.1023/b:ejep.0000032348.83087.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There is little information on the epidemiology characterisation of HCV isolates in Tunisia. Previous report showed predominance of genotype 1b. In this study, 32 HCV isolates from genotypes 1a (n = 10), 1b (n = 14), 2 (n = 4), 3a (n = 3) and 4 (n = 1) were genotyped by sequencing and phylogenetic analysis on the non-structural 5b (NS5b) region. The isolates originated from 14 patients with chronic hepatitis, 10 haemophiliacs and eight healthy blood donors. NS5b sequence grouping was concordant with previous 5' untranslated region (5'UTR) genotyping results in 91% of cases. Most of the Tunisian isolates were closely related to the European ones, except for genotype 4 which seems to be related mostly to isolates from Egypt. Isolates from genotype 1a obtained from haemophiliacs showed distinct clustering and nucleic divergence from those obtained from non-haemophiliac patients, this underlines the particular mode of contamination of this group of patients.
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Affiliation(s)
- Ahlem Djebbi
- Laboratory of Clinical Virology, Institut Pasteur de Tunis, Tunisia
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31
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Carmo RA, Oliveira GC, Guimarães MDC, Oliveira MS, Lima AA, Buzek SC, Corrêa-Oliveira R, Rocha MOC. Hepatitis C virus infection among Brazilian hemophiliacs: a virological, clinical and epidemiological study. Braz J Med Biol Res 2002; 35:589-98. [PMID: 12011945 DOI: 10.1590/s0100-879x2002000500012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We determined and analyzed risk factors of hepatitis C virus (HCV)-infected Brazilian hemophiliacs according to their virological, clinical and epidemiological characteristics. A cross-sectional and retrospective study of 469 hemophiliacs was carried out at a Brazilian blood center starting in October 1997. The prevalence of HCV infection, HCV genotypes and factors associated with HCV RNA detection was determined. The seroprevalence of anti-HCV antibodies (ELISA-3.0) was 44.6% (209/469). Virological, clinical and epidemiological assessments were completed for 162 positive patients. There were seven (4.3%) anti-HCV seroconversions between October 1992 and October 1997. During the same period, 40.8% of the positive anti-HCV hemophiliacs had abnormal alanine transaminase (ALT) levels. Plasma HCV RNA was detected by nested-RT-PCR in 116 patients (71.6%). RFLP analysis showed the following genotype distribution: HCV-1 in 98 hemophiliacs (84.5%), HCV-3 in ten (8.6%), HCV-4 in three (2.6%), HCV-2 in one (0.9%), and not typeable in four cases (3.4%). Univariate analysis indicated that older age (P = 0.017) and abnormal ALT levels (P = 0.010) were associated with HCV viremia, while the presence of inhibitor antibodies (P = 0.024) and HBsAg (P = 0.007) represented a protective factor against the presence of HCV RNA. These findings may contribute to a better understanding of the relationship between HCV infection and hemophilia.
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Affiliation(s)
- R A Carmo
- Fundação Hemominas, Alameda Ezequiel Dias 321, 30130-110 Belo Horizonte, MG, Brazil.
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32
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Weir RP, Brunton CR, Blakely TA. Chronic liver disease mortality attributable to hepatitis B and C in New Zealand. J Gastroenterol Hepatol 2002; 17:582-8. [PMID: 12084033 DOI: 10.1046/j.1440-1746.2002.02743.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND This research aimed to estimate the prevalence and population attributable risk percent (PAR%) of hepatitis B (HBV) and C (HCV) infection among chronic liver disease (CLD) deaths in New Zealand. The PAR% is the percentage of CLD cases attributable to either HBV or HCV. Within New Zealand, there are large differences in HBV prevalence by ethnic group, so prevalence and PAR% estimates were made separately for the three major ethnic groups. METHODS The study sample was selected from CLD deaths between 1992 and 1997. Data were extracted from hospital records and coroners' reports. The prevalence and PAR% of HBV and HCV were estimated. RESULTS Data were extracted for 303 of 359 decedents selected for inclusion. Hepatitis B virus and HCV test results were identified in 67 and 43%, respectively. Among those cases tested, the prevalence (and estimated PAR%) of HBV infection was 68% (PAR% 66%) for Pacific people, 54% (PAR% 52%) for Maori and 10% (PAR% 10%) for European New Zealanders. The prevalence (and estimated PAR%) of past or present HCV infection ranged between 8 and 15% (PAR% 8-14%) for the three major ethnic groups. CONCLUSIONS The present study has demonstrated that HBV and HCV infections are important contributors to CLD mortality in New Zealand. With the introduction of universal hepatitis B vaccination in the late 1980s, we would expect the burden of CLD deaths attributable to HBV to decrease in the future. However, the burden of CLD deaths due to HCV is likely to increase.
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Affiliation(s)
- Robert P Weir
- New Zealand Health Technology Assessment, Christchurch School of Medicine and Health Sciences, New Zealand.
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33
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Omer RE, Van't Veer P, Kadaru AM, Kampman E, el Khidir IM, Fedail SS, Kok FJ. The role of hepatitis B and hepatitis C viral infections in the incidence of hepatocellular carcinoma in Sudan. Trans R Soc Trop Med Hyg 2001; 95:487-91. [PMID: 11706655 DOI: 10.1016/s0035-9203(01)90013-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In Sudan, the incidence of hepatocellular carcinoma (HCC) is high and increasing. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are important risk factors of HCC. This study aims to assess the role of HBV and HCV infections in the incidence of HCC in 2 regions of Sudan. A case-control study was conducted in 1996-98 among 150 HCC patients and 205 controls from 2 regions in Sudan. Their demographic characteristics as well as food habits and chronic conditions have been investigated. In this study, 115 cases and 199 controls were tested for hepatitis B surface antigen (HBsAg) and for HCV antibodies. Strong positive associations were found between HBV or HCV, and HCC with odds ratios (ORs) 9.8 (95% CI 5.1-18.9) and 8.3 (95% CI 2.3-29.9), respectively. After adjustment for age, by logistic regression, the ORs for HBV and HCV were 16.1 (95% CI 7.4-34.9) and 4.5 (95% CI 1.1-18.6), respectively. Further adjustment for region, education level and job type did not appreciably affect the results. Given a prevalence of HBV and HCV of 7.0% and 1.5% among controls, about 57% of all HCC cases can be attributed to these viral infections. Hepatitis infections seem to be important risk factors for HCC in Sudan.
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Affiliation(s)
- R E Omer
- Department of Crop Protection, Faculty of Agriculture, University of Khartoum, Sudan
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34
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Hassan MM, Zaghloul AS, El-Serag HB, Soliman O, Patt YZ, Chappell CL, Beasley RP, Hwang LY. The role of hepatitis C in hepatocellular carcinoma: a case control study among Egyptian patients. J Clin Gastroenterol 2001; 33:123-6. [PMID: 11468438 DOI: 10.1097/00004836-200108000-00006] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Egypt has one of the highest prevalence rates of hepatitis C virus (HCV) infection in the world; however, the risk and attribution related to HCV in Egyptian patients with hepatocellular carcinoma (HCC) remains unknown. GOALS The current study was undertaken to estimate the risk of HCC in relation to HCV in Egypt. STUDY Thirty-three patients with HCC and 35 healthy controls who had a similar socioeconomic status were prospectively enrolled at the University of Cairo National Cancer Institute. RESULTS Anti-HCV antibodies were present in 75.8% of the patients and in 42.9% of the controls (p = 0.01); hepatitis B surface antigen (HBsAg) was present in 15.2% of the patients and in 2.9% of the controls (p = 0.03). In addition, the sex-and age-adjusted odds ratio (OR) for anti-HCV antibodies was 5.1 (95% CI = 1.5-17.4) and for HBsAg was 13.2 (95% CI = 1.2-148.2). Concurrent Schistosoma mansoni and anti-HCV was associated with an OR of 10.3 (95% CI = 1.3-79.8), which was higher than that for anti-HCV (6.5; 95% CI = 1.6-26.6) and S. mansoni infection (0.2; 95% CI = 0.1-6.2) alone. Finally, we estimated the attributable fraction of HCC to HCV to be 64% in this study population and 48% in the general Egyptian population. CONCLUSIONS Both HCV and hepatitis B virus infection increase the risk of HCC in Egyptian patients, whereas isolated Schistosoma infection does not. Because of the very high prevalence rate of HCV in the general Egyptian population, it accounts for most HCC cases in Egypt.
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Affiliation(s)
- M M Hassan
- Department of Gastrointestinal Oncology and Digestive Diseases, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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35
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Affiliation(s)
- J J Joubert
- Department of Medical Virology, University of Stellenbosch, Tygerberg, South Africa
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36
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Aquino RT, Chieffi PP, Catunda SM, Araújo MF, Ribeiro MC, Taddeo EF, Rolim EG. Hepatitis B and C virus markers among patients with hepatosplenic mansonic schistosomiasis. Rev Inst Med Trop Sao Paulo 2000; 42:313-20. [PMID: 11136517 DOI: 10.1590/s0036-46652000000600003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the frequency and the consequences of the co-infection of hepatitis B and C viruses in patients with hepatosplenic schistosomiasis (HSS). METHODS B and C serologic markers, exposure to risk factors, biochemical assays, upper gastrointestinal endoscopies, and abdominal ultrasonograms were evaluated in 101 patients with HSS from 1994 to 1997. Whenever possible, PCR was tested and histopathological studies were reviewed. RESULTS At least one HBV virus marker was found in 15.8%, and anti-HCV was detected in 12.9% of the subjects. The seropositive subjects tended to be older than the seronegative ones. A history of blood transfusion was significantly related to the presence of anti-HCV. Three (18.75%) out of 16 subjects exposed to B virus were HBsAg positive. Eleven (84.6%) out of thirteen patients who were anti-HCV positive demonstrated viral activity. Patients with ongoing viral infection presented a higher average level of liver aminotransferases, a higher frequency of cell decompensation and a higher rate of chronic hepatitis. Portal hypertension parameters were not influenced by viral exposure. CONCLUSIONS The rate of hepatitis B and C viruses serologic markers observed in the patients with HSS was higher than the control group. The co-infection was responsible for a higher frequency of cell decompensation.
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Affiliation(s)
- R T Aquino
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, 01277-900, Brasil
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37
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El Desoky ES, Ahmed AM, Nafeh MA, Ahmed HA, Schütz E, Armstrong VW, Oellerich M. Assessment of liver function by the MEGX test in patients with schistosomiasis and cirrhosis. Clin Biochem 1999; 32:207-12. [PMID: 10383082 DOI: 10.1016/s0009-9120(99)00007-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effect of schistosomiasis infection on hepatic function in Egyptian patients with posthepatitic cirrhosis. DESIGN AND METHODS Hepatic function, was assessed in 66 Egyptian patients, with (n = 30) and without (n = 36) schistosomal liver fibrosis due to Schistosoma mansoni and in 20 healthy controls, using the monoethylglycinexylidide (MEGX) test. Serum MEGX concentrations were measured before and 5, 15, 30, 60, 120, and 180 min after a lidocaine bolus. The sero-prevalence of antibodies to hepatitis C was also determined in the patients. RESULTS MEGX test results were significantly lower in patients than in controls at all time points. MEGX test results declined with advancing Child Class. Receiver operating characteristic (ROC) curve analysis revealed the following areas under the ROC curves for discrimination of Child Class C from Child Classes A/B: 30 min, 0.762; 60 min, 0.743; 120 min, 0.731; 15 min, 0.728; 180 min, 0.728; 5 min, 0.602. Schistosomiasis infection had no influence on MEGX test results when cirrhotic patients with (Schisto+) and without (Schisto-) schistosomiasis were compared. While the prevalence of the hepatitis B surface antigen was only 16.7% (Schisto-) and 26.7% (Schisto+), there was an extremely high sero-prevalence of antibodies to hepatitis C (HCV) in both groups: 88.9% (Schisto-) and 73.3% (Schisto+). CONCLUSIONS The association of schistosomal liver fibrosis with cirrhosis does not additionally influence MEGX formation. In addition, HCV rather than schistosomiasis infection must be considered as a major cause for the progressive liver disease in these patients.
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Affiliation(s)
- E S El Desoky
- Department of Pharmacology, Faculty of Medicine, Assuit University, Egypt
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38
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Wansbrough-Jones MH, Frimpong E, Cant B, Harris K, Evans MR, Teo CG. Prevalence and genotype of hepatitis C virus infection in pregnant women and blood donors in Ghana. Trans R Soc Trop Med Hyg 1998; 92:496-9. [PMID: 9861360 DOI: 10.1016/s0035-9203(98)90887-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The seroprevalence of hepatitis C virus was evaluated in blood donors and antenatal clinic attenders in Kumasi, Ghana and seropositive subjects were tested for hepatitis C virus ribonucleic acid by the polymerase chain reaction (PCR). The overall seroprevalence among Ghanaians was 2.8% but there was a significantly higher prevalence in males (4.6%) than in females (1.0%). No risk factor for infection was identified by a questionnaire. Among those who showed evidence of active infection with a positive PCR, the most common genotype was type 2 but the subtype could not be specifically determined; these type 2 hepatitis C viruses may be indigenous to Africa.
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Affiliation(s)
- M H Wansbrough-Jones
- Division of Infectious Disease, St George's Hospital Medical School, London, UK.
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Donato F, Boffetta P, Puoti M. A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma. Int J Cancer 1998; 75:347-54. [PMID: 9455792 DOI: 10.1002/(sici)1097-0215(19980130)75:3<347::aid-ijc4>3.0.co;2-2] [Citation(s) in RCA: 386] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of the study was to assess whether co-infection by hepatitis-B virus (HBV) and hepatitis-C virus (HCV) is associated with a higher risk of developing hepatocellular carcinoma (HCC) than each infection alone. A meta-analysis of data published up to June 1997 was performed. HBsAg and anti-HCV antibodies or HCV RNA (anti-HCV/HCV RNA) were considered as serological markers of current HBV and HCV infection respectively. A total of 32 case-control studies were suitable for a quantitative overview. The summary odds ratios (OR) were 13.7 for HBsAg positivity and 11.5 for anti-HCV/HCV RNA positivity. The OR for anti-HCV was lower among studies using second- or third-generation anti-HCV or HCV RNA (OR, 8.2) with respect to studies with first-generation anti-HCV test (OR, 19.1). When combining data from the studies with second- or third-generation anti-HCV or HCV RNA, the OR for HBsAg positivity and anti-HCV/HCV RNA negativity was 22.5 (95% confidence interval (CI), 19.5-26.0), the OR for anti-HCV/HCV RNA positivity and HBsAg negativity was 17.3 (95% CI, 13.9-21.6), and the OR for both markers positivity was 165 (95% CI: 81.2-374, based on 191 cases and 8 controls exposed). A synergism was found between HBV and HCV infections, the OR for co-infection being greater than the sum and lower than the product of those for each infection alone. The interaction was therefore negative according to the multiplicative model, providing epidemiological evidence both of an independent effect and of interference between the 2 viruses in the carcinogenic process.
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Affiliation(s)
- F Donato
- Cattedra di Igiene, Università di Brescia, Italy.
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40
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Donato F, Boffetta P, Puoti M. A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma. Int J Cancer 1998. [DOI: 10.1002/(sici)1097-0215(19980130)75:3%3c347::aid-ijc4%3e3.0.co;2-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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41
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Quinti I, el-Salman D, Monier MK, Hackbart BG, Darwish MS, el-Zamiaty D, Paganelli R, Pandolfi F, Arthur RR. HCV infection in Egyptian patients with acute hepatitis. Dig Dis Sci 1997; 42:2017-23. [PMID: 9365128 DOI: 10.1023/a:1018897813268] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The diagnostics of community-acquired acute HCV hepatitis in an endemic area was studied in 110 Egyptian patients with acute jaundice. In the first week of the jaundiced period 30 of 110 patients (27.3%) had anti-HCV antibodies. The majority already showed high levels of anti-HCV IgG (25/30), associated with anti-HCV IgM in nine of them. Five patients showed only an HCV IgM reactivity. Seven had also anti-HEV and/or anti-HBV: their jaundice could then be related to an acute infection caused by those viruses. All patients were infected with genotype 4a, in three associated with the 3a. During the follow-up five patients seroconverted for IgG, while their anti-HCV IgM did not show a uniform pattern of reactivity. Patients with positive serology suspected of an acute HCV infection were older than the patients with other acute hepatitis and showed a lower peak of ALT level. Seroconversion during acute hepatitis strongly indicated HCV as the etiologic agent. However, the detection of anti-HCV IgG antibodies in the jaundiced period showed that the majority of patients had already seroconverted to anti-HCV antibodies; in most of them it is possible to hypothesize a reactivation of a chronic HCV infection.
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Affiliation(s)
- I Quinti
- Department of Allergy and Clinical Immunology, University La Sapienza, Rome, Italy
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42
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Arthur RR, Hassan NF, Abdallah MY, el-Sharkawy MS, Saad MD, Hackbart BG, Imam IZ. Hepatitis C antibody prevalence in blood donors in different governorates in Egypt. Trans R Soc Trop Med Hyg 1997; 91:271-4. [PMID: 9231192 DOI: 10.1016/s0035-9203(97)90070-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were sought in serum samples from 2644 blood donors in 24 of Egypt's 26 governorates. Of the 2644 samples, 656 (24.8%) were shown to contain anti-HCV immunoglobulin G antibody by Abbott second generation enzyme immunoassays (EIA). Of 85 EIA-positive samples tested by recombinant immunoblot assay, 72 (85%) were positive. HCV seroprevalence in the governorates ranged from zero to 38%; 15 governorates (62%) had an HCV antibody prevalence greater than 20%, and 6 (25%) greater than 30%. Governorates with higher sero-prevalences were located in the central and north-eastern Nile river delta, and south of Cairo in the Nile river valley. Subjects from areas in and adjoining the Sinai peninsula, in the eastern and western desert, and in southernmost Egypt, had the lowest prevalence of HCV antibody. The large urban governorates of Cairo and Alexandria had antibody prevalences of 19% and 11%, respectively. A total of 39.4% subjects had evidence of HBV infection (and-HBV core antigen total antibody). HCV infections were detected more frequently in donors with markers for HBV infections than in uninfected subjects (36% versus 18%, P < 0.001).
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Affiliation(s)
- R R Arthur
- Virology Branch, United States Naval Medical Research Unit no. 3, Cairo, Egypt
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Angelico M, Renganathan E, Gandin C, Fathy M, Profili MC, Refai W, De Santis A, Nagi A, Amin G, Capocaccia L, Callea F, Rapicetta M, Badr G, Rocchi G. Chronic liver disease in the Alexandria governorate, Egypt: contribution of schistosomiasis and hepatitis virus infections. J Hepatol 1997; 26:236-43. [PMID: 9059941 DOI: 10.1016/s0168-8278(97)80036-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/AIMS In Egypt chronic liver disease is customarily attributed to Schistosoma mansoni infection. Anti-HCV antibodies are highly prevalent among Egyptian blood donors, yet little is known about the risk factors, pathogenicity and virological features of HCV and its association with schistosomiasis. We studied 135 adult patients with chronic liver disease living in the Alexandria governorate, mostly in rural areas of the Nile Delta. METHODS Evaluation included abdominal ultrasonography; detection of anti-HCV antibodies and markers of HBV and HDV infection; HCV-RNA assay by 5' untranslated region nested polymerase-chain-reaction and HCV genotyping by a line probe assay; serologic (anti-soluble egg antigen, anti-SEA) and parasitological examinations for Schistosoma mansoni infection; and liver biopsy, if not contraindicated. RESULTS Ninety-one (67%) patients had anti-HCV and 107 (85%) anti-SEA, 32 (30%) of whom excreted schistosomal eggs in stools. In addition, 21 (16%) patients had HBsAg, 86 (64%) anti-HBc and four (3%) anti-delta. Thus, many patients had evidence of multiple infections, double in 66% (anti-HCV and anti-SEA), triple in 33% (anti-HCV HBsAg and anti-SEA). Based on our diagnostic criteria, 25 (19%) patients had schistosomal portal fibrosis (anti-HCV positive in eight), 24 (18%) chronic hepatitis (anti-HCV positive in 19), 76 (56%) cirrhosis (anti-HCV positive in 58) and 10 hepatic tumors (anti-HCV positive in six). At multivariate analysis, the presence of anti-HCV was independently associated with previous parenteral anti-schistosomal therapy, a history of hematemesis and seropositivity for anti-HBc. Fifty (55%) of 91 anti-HCV positive sera had HCV-RNA, in 41 cases classified as genotype 4a. Detection of HCV-RNA was associated with a more severe liver disease and occurred less frequently in patients with a history of schistosomiasis. CONCLUSIONS HCV infection with genotype 4a is the main cause of severe chronic liver disease in Egypt, where it is highly associated with schistosomiasis.
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Affiliation(s)
- M Angelico
- Department of Public Health, Tor Vergata University, Rome
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Glikberg F, Brawer-Ostrovsky J, Ackerman Z. Very high prevalence of hepatitis B and C in Bukharian Jewish immigrants to Israel. J Clin Gastroenterol 1997; 24:30-3. [PMID: 9013347 DOI: 10.1097/00004836-199701000-00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In Israel, the reported prevalence of hepatitis-C virus (HCV) infection among blood donors is 0.44%. As we found a high prevalence of chronic hepatitis-B virus (HBV) and HCV infection in Jewish immigrants from Uzbekistan and Tajikistan (Bukharian Jews) among our general patient population, we determined the prevalence of HBV and HCV infection among "healthy" Bukharian Jewish immigrants by screening for HBV and HCV markers and risk factors in a population of Bukharian Jews in north Jerusalem. A total of 27 (26.5%) of 102 patients were anti-HCV positive (by ELISA and confirmation tests). The HCV positive patients were older and had a higher rate of liver enzyme abnormalities than were the HCV-negative patients (56.5 +/- 2.3 versus 47.6 +/- 1.8, p = 0.003; and 14 of 27 versus 7 of 75, p < 0.01, respectively). HCV-positive patients with liver enzyme abnormalities were younger than HCV-positive patients without liver enzyme abnormalities (52.5 +/- 3.0 versus 62.8 +/- 2.8, p = 0.02). Sixteen patients (15.7%) were hepatitis-B surface antigen (HBsAg) carriers, and only two of these HBsAg carriers had liver enzyme abnormalities. None of the HCV-positive patients were HBsAg carriers (0 of 27 among HCV-positive patients versus 16 of 75 among HCV-negative patients, p = 0.0055). Past infection with HBV was found in 67 examinees (66%) (45 of 75 HCV-negative patients and 22 of 27 HCV-positive patients, p = 0.058). However, similar proportions of patients from both groups had past and present exposure to HBV [61 (81.3%) of 75 among HCV-negative patients versus 22 (81.5%) of 27 among HCV-positive patients]. Only 14 patients (13.7%) had no exposure to either HCV or HBV. Possible risk factors were use of nondisposable needles during mass vaccination in the U.S.S.R. or possible intrafamilial spread. The study concluded that immigrant Jews from former Asiatic U.S.S.R. republics have the highest rate of HCV positivity ever reported, and many of them have past and present HBV infection. Measures to prevent intrafamilial transmission of both viruses should be instituted.
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Affiliation(s)
- F Glikberg
- Department of Family Medicine, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel
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