Role of hepatitis C infection in chronic liver disease in Egypt.

Strickland, G. Thomas; Elhefni, Hanaa; Salman, Tary; Waked, Imam; Abdel‐Hamid, Mohamed; Mikhail, Nabiel; Esmat, Gamal; Fix, Alan

doi:10.4269/ajtmh.2002.67.436

Cited by 114 publications

(80 citation statements)

References 40 publications

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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Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors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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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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“…[6][7][8] HCC is the second most frequent cause of cancer incidence and mortality among men in Egypt. 9 Hospitalbased studies from Egypt have reported an increase in the relative frequency of all liver-related cancers in Egypt (>95% as HCC), from 4.0% in 1993 to 7.3% in 2003.…”

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confidence: 99%

Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: A systematic review and meta‐analysis

Lehman

Wilson

2008

Intl Journal of Cancer

127

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Liver cancers are strongly linked to hepatitis B virus (HBV) and hepatitis C virus (HCV). Egypt has the highest prevalence of HCV worldwide and has rising rates of hepatocellular carcinoma (HCC). Egypt's unique nature of liver disease presents questions regarding the distribution of HBV and HCV in the etiology of HCC. Accordingly, a systematic search of MEDLINE, ISI Web of Science, ScienceDirect and World Health Organisation databases was undertaken for relevant articles regarding HBV and HCV prevalence in Egypt among healthy populations and HCC cases. We calculated weighted mean prevalences for HBV and HCV among the populations of interest and examined differences in prevalence by descriptive features, including age, year and geographic region. Prevalences for HBV and HCV were 6.7% and 13.9% among healthy populations, and 25.9% and 78.5% among HCC cases. Adults had higher prevalences of both infections (Adult HBV 5 8.0%, Child HBV 5 1.6%; Adult HCV 5 15.7%, Child HCV 5 4.0%). Geographically, HBV was higher in the south, whereas HCV was greater in the north (North HBV 5 4.6%, South HBV 5 11.7%; North HCV 5 15.8%, South HCV 5 6.7%). Among HCC cases, HBV significantly decreased over time (p 5 0.001) while HCV did not, suggesting a shift in the relative influences of these viruses in HCC etiology in Egypt. Our results highlight large amounts of heterogeneity among the epidemiological factors associated with liver disease in Egypt and underscore the necessity of an integrated strategy for the successful prevention of viral hepatitis infections and chronic liver disease. ' 2008 Wiley-Liss, Inc.Key words: pooled analysis; liver cancer; infectious diseases; developing countries Hepatocellular carcinoma (HCC) comprises nearly 6% of all incident cancer cases worldwide, with the overwhelming majority occurring in the developing world.1 One of the least curable malignancies, HCC is the third most frequent cause of cancer mortality among men worldwide.1 Chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) have been cited as, by far, the most important etiologic agents.2 According to the World Health Organisation (WHO), 350 million people are chronically infected with HBV and 170 million are infected with HCV.3,4 The relative importance of HBV and HCV as causative agents can vary greatly from region to region and over time.1,5 Selecting appropriate HCC prevention and control methods, therefore, depends on understanding the dynamics of these agents in a specified geographic region.Incidence of HCC in Egypt is currently increasing, which may be the result of a shift in the relative importance of HBV and HCV as primary risk factors.6-8 HCC is the second most frequent cause of cancer incidence and mortality among men in Egypt.9 Hospitalbased studies from Egypt have reported an increase in the relative frequency of all liver-related cancers in Egypt (>95% as HCC), from 4.0% in 1993 to 7.3% in 2003.6-8 The Middle East Cancer Consortium recently reported that the incidence rate among males was 7 times greater...

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“…Though all patients who developed this side effect were hepatitis C positive, this could hardly been seen as a cause and effect relationship. Hepatitis C is known to be endemic in Egypt where prevalence of antibodies to HCV (anti-HCV) is approximately tenfold greater than in the United States and Europe (20). Hence, a substantial percentage of patients in this material are expected to be hepatitis C positive.…”

Section: Discussionmentioning

confidence: 99%

A phase II trial of adjuvant low-dose total body irradiation in non-hodgkin's lymphoma patients following standard CHOP

Safwat¹,

Bayoumi²,

Akkoush³

et al. 2004

Acta Oncologica

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Role of hepatitis C infection in chronic liver disease in Egypt.

Cited by 114 publications

References 40 publications

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

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

Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: A systematic review and meta‐analysis

A phase II trial of adjuvant low-dose total body irradiation in non-hodgkin's lymphoma patients following standard CHOP

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