and often fulminant course of the disease. Additionally, HCV patients may be at a higher than an average risk of acquiring hepatitis B because of the similar routes of transmission of both viruses. HBV infection can be prevented by the administration of a safe and immunogenic vaccine. Insufficient immune response to hepatitis B virus (HBV) vaccine in patients with chronic hepatitis C virus is frequently encountered and anti-HBs levels may persist for a shorter time than among immune competent persons. The purpose of present study was to determine long-term persistence of anti-HBs among Egyptian patients with chronic hepatitis C infection. It also assesses the need and response to a subsequent challenge with vaccine booster doses. METHODS: 200 individuals were enrolled; (GI) 100 patients suffered from chronic HCV infection and 100 healthy individuals as a control (GII). Both groups were matched in regard to age and sex. Each individual received a standard 3-dose series of HBV vaccine; 20µg recombinant DNA vaccine of HBV(Euvax-B LG Life science, Korea) administered by IM injection into deltoid muscle at 0, 1, 6 months interval. HBs antibody titer was measured after 4 weeks. Suboptimal or Non-responders (anti-HBs titer < 10 IU/L) received a booster dose and reevaluated after 4 weeks; Suboptimal response of group I (42 patients) divided into 2 subgroups: GIa (21 patients), which received 40 µg(double dose) recombinant HBV vaccine and GIb (21 patients), received standard adult dose 20 µg HBV vaccine. 11 individuals with suboptimal response of G II received standard adult dose 20 µg HBV vaccine too. CONCLUSION: Chronic HCV patients showed lower response rate for standard doses of HBV vaccine especially with advancing age, diabetes and hypoalbuminemia. A double booster dose (40 μg) vaccine would be recommended for them which are better than revaccination with the standard 3 doses recombinant HBV vaccine.
Background: Hepato cellular carcinoma (HCC) represents a challenging malignancy of worldwide importance; it is the sixth most common cancer and the third most common cause of cancer-related death globally. Alcohol, tobacco, obesity, diabetes and viral etiology interact to increase the risk of HCC in patients with chronic liver diseases. Smoking is a well documented risk factor for many cancers and can play role in cancer development in patients with liver diseases. Egypt has a significant prevalence of HBV, HCV, bilharzial infections and smoking which may allow us to identify a high-risk group for HCC among patients with chronic liver diseases and cirrhosis. Aim:The aim of this study is to evaluate the impact of smoking as a co-factor for HCC development in Egyptian patients with chronic hepatitis B and/or C with or without Schistosomal infestation. Patients and method:A case control study was conducted on 320 Egyptian patients with chronic liver disease (CLD): 160 patients with HCC (Group I) and 160 patients without focal lesion (Group II) as a control group. All patients were assigned to full history taking with emphasis on special habits especially smoking, family history; clinical examination, laboratory investigations, abdominal ultrasound, rectal snip for bilharzial infestation and liver biopsy was conducted in some cases when imaging was inconclusive.Results: There was no statistical significant difference between HCC cases and control group as regards age, gender nor residence. Out of 320 patients enrolled in this study, only 95(29.69%) patients were non smokers, most patients were smokers 225(70.31%). Among the smokers, males were more than females and most of them were heavy smokers. The HCC patients were found more with heavy smoking than control patients. All smokers were liable for developing HCC 1.8times more than non smokers (OR: 1.8, CI: 0.89-3.32) while heavy smokers were 3.15times more liable than non smokers (OR: 3.15, CI: 1.45-7). Smoking men with were liable to develop HCC 2.63times more than non smokers (OR: 2.63, CI: 1.06-5.83) and heavy smokers 2.55times more than non smokers (OR: 2.55, CI: 0.96-6.35), urban smokers were liable to develop HCC 3.57times more than non smokers (OR: 3.57, CI: 1.15-11.58) and heavy smokers 3.48times more than non smokers (OR: 3.48, CI: 0.86-13.9); Smokers with chronic HCV infection were liable to develop HCC 1.51times more than non smokers (OR: 1.51, CI: 0.60-2.94) and heavy smokers 2.6times more than non smokers (OR: 2.6, CI: 0.95-5.96). Smokers with cirrhosis were liable to develop HCC 2.17 times more than non smokers (OR: 2.17, CI: 0.93-5.07) and heavy smokers 4times more than non smokers (OR: 4, CI: 1.95-13.10). Conclusion:The study revealed that smoking for long duration in CLD (chronic HBV, HCV infections and liver cirrhosis) is a highly risk factor for development of HCC among Egyptians.Recommendations: Many efforts are needed to help and promote complete cessation of smoking generally and specially in patients with chronic liver diseases. Follow up of a...
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