Chronic liver disease in the Alexandria governorate, Egypt: contribution of schistosomiasis and hepatitis virus infections

Angélico, M.; Renganathan, E.; Gandin, Claudia; Fathy, M.; Profili, Manuel; Rafai, Wael; Santis, Adriano De; Nagi, A.; Amin, G.A.M.; Capocaccia, L.; Callea, F; Rapicetta, Maria; Badr, Gamal; Rocchi, G

doi:10.1016/s0168-8278(97)80036-0

Cited by 121 publications

(133 citation statements)

References 27 publications

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“…Although, the present study has showed that few HCV infected individuals presented known risk factors, for the large majority the mode of transmission remained undefined in agreement with other studies in general population (Chiaromante et al 1996, MacDonald et al 1996, Angelico et al 1997. Studies using more detailedepidemiological questionnaires are needed in order to clarify this subject.…”

Section: Discussionsupporting

confidence: 87%

“…Surveys on HCV generally show that the infection occurs mainly as a cohort effect in subjects aged more than 45 years (Chiaromante et al 1996, Diago et al 1996. The use of non-disposable syringes and needles, a commonplace until two decades ago, is considered as a facilitating factor to HCV spread in some of these surveys (Chiaromante et al 1996, Angelico et al 1997. Common tropical diseases in Amazon, such as malaria and leishmaniasis, frequently need parenteral treatment and hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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Hepatitis C virus prevalence among an immigrant community to the Southern Amazon, Brazil

Souto

Fontes

Martelli

et al. 1999

Mem. Inst. Oswaldo Cruz

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A community-based random survey was conducted in a southern Brazilian Amazonian county aiming to investigate hepatitis C virus (HCV) infection prevalence and the association of demographic variables and lifestyle behaviours. Seven hundred eighty individuals were serologically screened with a third generation enzyme-linked immunosorbent assay to detect anti-HCV antibodies between 1994/1995. Positive samples were retested for confirmation with a line immunoassay (LIA, Inno-LIA HCV Ab III). Most of these subjects were low income and came from southern Brazilian states (65.8). Two point four percent (IC 95% 1.2%-4.6%) of the subjects had LIA-confirmed anti-HCV antibodies reactivity. The age-specific prevalence of HCV antibodies slightly increased with age, with the highest prevalence after the age of 40 years. The results of multivariate analysis indicate a strong association between HCV antibodies and previous surgery and history of intravenous drug use. There were no apparent association with gender, hepatitis B virus markers, blood transfusion, and sexual activity. Mean time living in Amazon did not differ between confirmed and negative anti-HCV individuals. The present data point out an intermediate endemicity of HCV infection among this immigrant community to the Amazon region and that few HCV infected participants presented known risk factors.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus prevalence among an immigrant community to the Southern Amazon, Brazil

Souto

Fontes

Martelli

et al. 1999

Mem. Inst. Oswaldo Cruz

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“…A case-control study that compared 237 outpatients seen at the National Liver Institute (cases) with 212 gender-and age-matched neighbors who denied liver disease (controls) supported this belief that HCV is the predominant cause of liver disease and that there is a large occult reservoir of HCV-caused chronic liver disease in the country. 26 Others also reported that HCV infection with genotype 4a was the main cause of chronic liver disease in 135 adult patients living in Alexandria 27 and in 801 residents of a Nile Delta community. 28 Case-control studies have shown that both HBV and HCV infection increase the risk of HCC (adjusted odds ratios of [3][4][5][6][7][8][9][10][11][12][13].…”

Section: Magnitude Of Hcv-caused Chronic Liver Disease In Egyptmentioning

confidence: 99%

Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors

2006

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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 as treatment for 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, particularly 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. (HEPATOLOGY 2006;43:915-922.)

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“…[20][21][22] This relationship does not appear to exist for hepatitis B virus (HBV). 23 Schistosomiasis, a major risk factor for the development of bladder cancer, 24 is hyperendemic in Egypt, and the death rates for bladder cancer are among the highest in the world.…”

mentioning

confidence: 99%

Hepatocellular carcinoma in Egyptians with and without a history of hepatitis B virus infection: association with hepatitis C virus (HCV) infection but not with (HCV) RNA level.

Yates

Hafez²,

Beld³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. The aim of this study was to analyze the association of hepatocellular carcinoma (HCC) with hepatitis C virus (HCV) in Egypt, using hepatitis B virus (HBV) and hepatitis E virus (HEV) as virus controls. In addition, the association of HCC with HCV RNA levels among persons seropositive for HCV was analyzed. We compared 131 patients with proven HCC, 247 with bladder cancer, and 466 healthy hospital employees. Age, sex, and place of residence were recorded to study confounding factors. Among the healthy controls, 16% were seropositive for HCV, 21% for HBV, and 31% for HEV. When healthy controls were age-matched with HCC patients, the latter were significantly (P Ͻ 0.001) more often HCV seropositive (67%) than were the controls (30%). The seropositivity for HBV and HEV did not differ significantly in frequency between the two groups. The seropositivity for HCV was also significantly (P Ͻ 0.001) more often found in HCC patients (76%) than in BC patients (47%), with seroprevalences for HBV and HEV not differing significantly in these age-matched groups. In HBV-negative HCC and bladder cancer patients, seroprevalence for HCV was significantly (P ϭ 0.002) higher in HCC patients (68%) than in bladder cancer patients (36%). This difference was even more pronounced (P Ͻ 0.001) in HBV-positive HCC and bladder cancer patients (78% versus 52%, respectively). Of HCV-seropositive individuals, 49% were HCV RNA positive by branched DNA assay, and of these, 96% were infected by HCV genotype 4. No correlation between HCV RNA load and seropositivity of HBV or age or disease state was found. Infection with HCV and HCV-HBV double infection, but not HBV or HEV infection alone, is strongly correlated with HCC in Egypt.Hepatitis C virus (HCV) causes more than 90% of parenterally transmitted non-A, non-B (NANBH) hepatitis.1-4 In more than 85% of HCV infections, the infection persists and leads to chronic hepatitis. 4,5 Once chronic hepatitis is established, it may slowly progress to worsening stages of fibrosis and cirrhosis and ultimately lead to the development of hepatocellular carcinoma (HCC). 1,[6][7][8] In the first two decades after acute HCV infection, both mortality and morbidity remain modest in frequency, but after this period both can be expected to increase.1,2 Infection with HCV is widely recognized as the most common indication for liver transplantation 9 in the United States, Europe, and Japan. Although no firm data are available, death rates for HCC in Egypt appear to be increasing over the last decade. 10,11 Hepatitis virus infections of any kind are highly prevalent in the general population. The relatively high prevalence of HCV infections in Egypt was first established in 1992 by Kamel and others. 12 Other groups thereafter found HCV seroprevalence rates ranging from 6% to 38% with an average of approximately 15%. [12][13][14][15][16] The reasons behind these high HCV infection rates being 5-35-fold higher than reported elsewhere in the world are still unknown. In Egypt, the HCV seroprevalence was 55% among ...

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Chronic liver disease in the Alexandria governorate, Egypt: contribution of schistosomiasis and hepatitis virus infections

Cited by 121 publications

References 27 publications

Hepatitis C virus prevalence among an immigrant community to the Southern Amazon, Brazil

Hepatitis C virus prevalence among an immigrant community to the Southern Amazon, Brazil

Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors

Hepatocellular carcinoma in Egyptians with and without a history of hepatitis B virus infection: association with hepatitis C virus (HCV) infection but not with (HCV) RNA level.

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