Chronic hepatitis C treatment: a review

Hepatitis C virus infection in southwestern Saudi Arabia: Are we still in the plateau phase?

The aim was to study the seroprevalence of Hepatitis C virus (HCV) infection and related risk factors in Aseer region in southwestern Saudi Arabia, the region known to be of the highest endemicity of viral hepatitis. In a cross-sectional study, all participants were interviewed using structured questionnaire. HCV infection was diagnosed using fourth-generation ELISA. All positive and equivocal HCV serology results were further confirmed by using a qualitative confirmatory RT-PCR. The study enrolled 10,234 participants. A seroprevalence of 2.2% (95%CI: 1.9-2.5%) was found. In multivariate logistic regression analysis, the study showed that males had significantly more risk to become seropositive for HCV (aOR = 1.437, 95%CI: 1.071-1.927) compared to females. Similarly, participants having history of blood transfusion had more than two times the risk of becoming seropositive for HCV (aOR = 2.079, 95%CI: 1.037-4.149). HCV infection in the study area is still high in the plateau phase. It is recommended to have an active educational and media campaign about the risks of HCV infections. Workshops and training of qualified laboratory staff related to blood banking seem mandatory. J. Med. Virol. 89:867-871, 2017. © 2016 Wiley Periodicals, Inc.

Distribution of hepatitis C virus genotypes in the Middle East

It is well established that hepatitis C develops into cirrhosis of the liver and hepatocellular carcinoma (HCC) both of which are fatal diseases. The World Health Organization estimates that there are at least 21.3 million hepatitis C virus (HCV) carriers in the Eastern Mediterranean countries, which is close to the number of carriers estimated in the Americas and Europe combined. With such a high disease burden of HCV infection in this part of the world, and in light of the new evidence that genotypes may influence the outcome of antiviral therapy, the focus of this review is on the epidemiology and distribution of HCV genotypes in the Eastern Mediterranean countries. Accumulated data show that there are two main patterns for the distribution of HCV genotypes in the Middle East: in the first pattern, genotype 4 is prevalent in most of the Arab countries, and in the second pattern, genotype 1a or 1b predominates in the non-Arab countries. Results from the limited number of clinical trials on the treatment of chronic HCV genotype 4 using peginterferon alfa-2b in combination with ribavirin are encouraging. However, efforts to develop more effective antiviral therapies and the establishment of an effective HCV vaccine remain the largest challenges for the near future.

Changing pattern of hepatitis viral infection in Saudi Arabia in the last two decades

BACKGROUND

Information on the epidemiology of viral hepatitis B, C and A in the Kingdom of Saudi Arabia (KSA) has accumulated over the last two decades. We review the changing epidemiology of these infections and suggest possible strategies for eradication.

METHODS

We screened Saudi medical journals and Medline for reports dealing with hepatitis B, C and A, and analyzed official of blood donor screening data from the Ministry of Health (MOH) Central Blood Bank and the King Khalid University Hospital (KKUH) Blood Bank.

RESULTS

Several studies from the 1980s found a high endemicity for HBV, with 5% to 10% of the population infected and prevalence varying from one region to another. In children (age 1 to 12 years), the prevalence was almost 7% in 1989, just before the addition of the HBV vaccine to the Extended Program of Immunization (EPI). By 1997, the prevalence of HBV infection in children had declined to 0.3%. Blood donor results have also shown a steady decrease in HBV infection. At KKUH, prevalence declined from 3.7% in 1987 to 1.7% in 2000. Hepatitis C infection has also shown a marked decline among Saudi blood donors at KKUH, HAV infection among children has declined from 50% in 1989 to 25% in 1997, but the infection rate is still high, reaching 50% in a few regions.

CONCLUSIONS

Hepatitis B, C, and A infection has declined in KSA in the last two decades by more than 50%. The reasons for this marked decline are multifactorial. An important reason is the adoption in the last two decades of the MOH strategy for prevention of viral hepatitis infection, which needs to continue. Improvements in the economic status of the population and the decline in illiteracy have also contributed to the decline in viral hepatitis infection.

Prevalence of resistance to antituberculosis drugs in Riyadh and a review of previous reports

BACKGROUND

Resistance to antituberculosis drugs is an important cause of treatment failure. We evaluated the prevalence and pattern of antituberculosis drug resistance in the central region of Saudi Arabia, and reviewed previous reports from Saudi Arabia.

MATERIALS AND METHODS

We retrospectively examined the records of sputum smear and culture-positive pulmonary tuberculosis patients admitted consecutively from 1998 through 1999 in a main referral hospital in Riyadh, and analyzed drug sensitivity reports. We also reviewed previous reports on antituberculosis drug resistance in Saudi Arabia.

RESULTS

Of 515 patients with pulmonary tuberculosis, 80 (15.5%) had resistance to at least one antituberculosis drug. Resistance to streptomycin was most frequent (9.7% ), followed by rifampicin (9.5%), isoniazid (4.3%), and ethambutol (0.2%). Resistance to one antituberculosis drug was found in 8.9%, resistance to two drugs in 5.2%, resistance to three drugs in 1.2%, and resistance to four drugs in 0.2%. Multidrug resistance (defined as resistance to at least isoniazid and rifampicin) was found in 1.9% of patients. A literature review including 6114 patients in Saudi Arabia showed that resistance against streptomycin was most common (8.8%), followed by rifampicin (8%), and isoniazid (7.2%). Of the 6114 patients, 6.8% patients were resistant to only one drug, 3.6% were resistant to two drugs, and 3.7% to three drugs.

CONCLUSION

The high prevalence of rifampicin resistance and resistance to multiple drugs in the Riyadh region and in other parts of Saudi Arabia is a major challenge to the control of tuberculosis in this country. Efforts should be made to prevent the emergence of further antituberculosis drug resistance.