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Characterizing hepatitis C virus epidemiology in Egypt: systematic reviews, meta-analyses, and meta-regressions. Sci Rep 2018; 8:1661. [PMID: 29374178 PMCID: PMC5785953 DOI: 10.1038/s41598-017-17936-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023] Open
Abstract
Egypt is the most affected nation by hepatitis C virus (HCV) and needs a comprehensive characterization of HCV epidemiology to inform the scale-up of treatment and prevention programs. Systematic reviews, meta-analyses, and meta-regressions were conducted. A total of 25 incidence, 259 prevalence, and 47 genotype studies were identified. Incidence and prevalence levels were high across all populations. Genotype 4 accounted for 94.1% of infections with a relative Shannon Diversity Index of only 14.4%. Pooled mean HCV prevalence was estimated at 11.9% (95% CI = 11.1–12.6%) among the general population, 55.6% (95% CI = 49.4–61.7%) among populations at high risk, 14.3% (95% CI = 10.3–18.8%) among populations at intermediate risk, 56.0% (95% CI = 50.4–61.6%) among populations with liver-related conditions, and 35.0% (95% CI = 27.3–43.1%) among special clinical populations. Mean HCV viremic rate was estimated at 66.7% (95% CI = 61.7–71.5%). Meta-regression indicated 6% lower odds for HCV prevalence for each one-year increment in publication year (AOR = 0.94; 95% CI = 0.92–0.96). HCV prevalence is high with evidence for ongoing transmission mainly through healthcare. Genotype diversity is low with genotype 4 dominance. Two-thirds of antibody-positive Egyptians are chronically infected and need treatment. Clinical populations should be prioritized for screening. Despite the large-scale epidemic, prevalence appears to be declining rapidly consistent with a contracting epidemic.
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Harfouche M, Chemaitelly H, Kouyoumjian SP, Mahmud S, Chaabna K, Al-Kanaani Z, Abu-Raddad LJ. Hepatitis C virus viremic rate in the Middle East and North Africa: Systematic synthesis, meta-analyses, and meta-regressions. PLoS One 2017; 12:e0187177. [PMID: 29088252 PMCID: PMC5663443 DOI: 10.1371/journal.pone.0187177] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/13/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To estimate hepatitis C virus (HCV) viremic rate, defined as the proportion of HCV chronically infected individuals out of all ever infected individuals, in the Middle East and North Africa (MENA). METHODS Sources of data were systematically-gathered and standardized databases of the MENA HCV Epidemiology Synthesis Project. Meta-analyses were conducted using DerSimonian-Laird random-effects models to determine pooled HCV viremic rate by risk population or subpopulation, country/subregion, sex, and study sampling method. Random-effects meta-regressions were conducted to identify predictors of higher viremic rate. RESULTS Analyses were conducted on 178 measures for HCV viremic rate among 19,593 HCV antibody positive individuals. In the MENA region, the overall pooled mean viremic rate was 67.6% (95% CI: 64.9-70.3%). Across risk populations, the pooled mean rate ranged between 57.4% (95% CI: 49.4-65.2%) in people who inject drugs, and 75.5% (95% CI: 61.0-87.6%) in populations with liver-related conditions. Across countries/subregions, the pooled mean rate ranged between 62.1% (95% CI: 50.0-72.7%) and 70.4% (95% CI: 65.5-75.1%). Similar pooled estimates were further observed by risk subpopulation, sex, and sampling method. None of the hypothesized population-level predictors of higher viremic rate were statistically significant. CONCLUSIONS Two-thirds of HCV antibody positive individuals in MENA are chronically infected. Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex. HCV viremic rate is a useful indicator to track the progress in (and coverage of) HCV treatment programs towards the set target of HCV elimination by 2030.
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Affiliation(s)
- Manale Harfouche
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Silva P. Kouyoumjian
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Sarwat Mahmud
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Karima Chaabna
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy & Research, Weill Cornell Medicine, Cornell University, New York, United States of America
| | - Zaina Al-Kanaani
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy & Research, Weill Cornell Medicine, Cornell University, New York, United States of America
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El-Serafi AT, Osama S, El-Zalat H, EL-Deen IM. Dysregulation of male sex hormones in chronic hepatitis C patients. Andrologia 2015; 48:82-6. [PMID: 25912488 DOI: 10.1111/and.12425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/30/2022] Open
Abstract
Chronic hepatitis C (HCV) infection is a serious problem all over the world and has a special importance in Egypt, where the prevalence of infection is 14.7% of population. In males, HCV is associated with sexual dysfunction and changes in the semen parameters. This study aimed at estimation of a panel of the most important related hormones in the serum of patients and illustration of their correlation to the routine laboratory investigations. The four studied hormones showed alteration in the patients in comparison with the controls. While androstenedione, prolactin and testosterone were significantly increased in patients, dehydroepiandrosterone sulphate was decreased. These changes in the hormones were not related to the liver functions, pathological grade or even viral load. We hypothesised a model of how HCV can induce these hormonal changes and recommended to add these hormones to the follow-up panel of male patients with HCV.
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Affiliation(s)
- A T El-Serafi
- Faculty of Medicine, Suez Canal University, Ismaillia, Egypt.,College of Medicine, University of Sharjah, Sharjah, UAE
| | - S Osama
- Faculty of Science, Port-Said University, Port-Said, Egypt
| | - H El-Zalat
- Port-Said Tropical Hospital, Port-Said, Egypt
| | - I M EL-Deen
- Faculty of Science, Port-Said University, Port-Said, 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: 0.8] [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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Elsadek Fakhr A, Pourkarim MR, Maes P, Atta AH, Marei A, Azab M, Van Ranst M. Hepatitis C Virus NS5B Sequence-Based Genotyping Analysis of Patients From the Sharkia Governorate, Egypt. HEPATITIS MONTHLY 2013; 13:e12706. [PMID: 24358038 PMCID: PMC3867025 DOI: 10.5812/hepatmon.12706] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 09/08/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic hepatitis C virus infection and its sequela are major health problems facing the Egyptian community. The high prevalence and spread rates of the disease require serious actions to stop or decrease these rates. Determination of HCV genotypes and subgenotypes adds significant knowledge about the epidemiology of the disease, and provides an added value in the decision making process of what strategy to follow and what therapy response to expect. The molecular epidemiology and genetic variability of HCV variants circulating in Egypt still need further analysis. OBJECTIVES The study was held to evaluate the genotype and subgenotype of the hepatitis c virus circulating in Sharkia as one of the large governorates of Egypt, which was not included in any study for genotyping of the virus before. PATIENTS AND METHODS The HCV molecular epidemiology in Sharkia governorate was studied using direct sequencing and further phylogenetic analysis of a partial NS5B region of the HCV genome from 63 patients. HCV genotype and subtype were successfully determined in 62 out of 63 patients. RESULTS The highest prevalent genotype was genotype 4a, which was found in 57 patients (92%) followed by 2 isolates (3%) with genotype 4o, 2 strains (3%) with genotype 1g and one isolate (2%) with genotype 4n. CONCLUSIONS This molecular epidemiology study revealed high prevalence of HCV genotype 4, subtype 4a among Egyptian patients residing in Sharkia governorate, Egypt.
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Affiliation(s)
- Ahmed Elsadek Fakhr
- Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Microbiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Reza Pourkarim
- Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IR Iran
| | - Piet Maes
- Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Amal Hassan Atta
- Microbiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ayman Marei
- Microbiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Magda Azab
- Microbiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Marc Van Ranst
- Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Corresponding Author: Marc Van Ranst, Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Minderbroedersstraat 10, 3000, Leuven, Belgium. Tel: +32-16347908, Fax: +32-16347900, E-mail:
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El-Tras WF, Tayel AA, El-Kady NN. Seroprevalence of hepatitis E virus in humans and geographically matched food animals in Egypt. Zoonoses Public Health 2012; 60:244-51. [PMID: 22812407 DOI: 10.1111/j.1863-2378.2012.01516.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of current study was to investigate the epidemiology of Hepatitis E virus (HEV) in humans and geographically matched food animals as a novel zoonotic assessment in Egypt. Blood samples were collected from patients who had a history of jaundice and attended to fever and general hospitals. Animal blood samples were collected from cows, buffaloes, sheep and goats convenient to HEV seropositive humans. Enzyme Immuno Assay (EIA) protocol was used to determine IgG anti-HEV. Sex and pregnancy were investigated as potential risk factors for HEV infection. Of 134 examined humans, 51 (38.1%) were positive for IgG anti-HEV. The males showed 26.8% seropositivity while the recorded female seropositivity was 50.8%, with a significant difference at P = 0.005, Odds Ratio (OR) = 0.35 at 95% confidence interval (CI): 0.17-0.73. There was a significant difference at P = 0.02 between seropositivity in pregnant (25%) and non-pregnant women (59.6%); OR was 0.23 (95% CI: 0.06-0.81). Anorexia was the most common symptom whereas paraesthesia and back pain were the least within icteric seropositive HEV humans. Hepatitis E virus seropositivity was recorded in 21.6%, 14%, 4.4% and 9.4% from examined cows, buffaloes, sheep and goats, respectively. The infected food animals were convenient to positive HEV humans who may declare the epidemiological picture of potential zoonotic HEV.
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Affiliation(s)
- W F El-Tras
- Department of Hygiene and Preventive Medicine (Zoonoses), Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
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Abstract
More than 20 years after the discovery of the hepatitis C virus (HCV), it is now well established that HCV is of global importance affecting all countries, leading to a major global health problem that requires widespread active interventions for its prevention and control. Chronic hepatitis C was linked to the development of cirrhosis and hepatocellular carcinoma in many areas of the world. Current epidemiological assessments have identified complex patterns with highly variable local prevalence rates between countries and within countries. HCV infection patterns have not significantly changed in most parts of the world since 1997, when first analyzed, partly due to the lack of new and more accurate data. The assessment of the national HCV prevalence and transmission modes should be completed to enable national authorities to prioritize preventive measures and to make the most appropriate use of available resources. The 'patchy' epidemiological situation in some areas will continue to complicate the task of the establishment of global, regional and national base line data. The present assessment finds a global prevalence of 2.35%, affecting 160 million chronically infected individuals. There is an urgent need for more accurate Information on the costs and burden of HCV to society. Twenty-one year after the discovery of HCV, the assessment is far from being complete and little progress has been made in the past 10 years in many countries. In some countries significant increases have been reported and this may also apply to countries were insufficient data exist. A safe and efficient vaccine against HCV is urgently needed.
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Affiliation(s)
- D Lavanchy
- Interlifescience, Massagno Ticino, Switzerland.
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Said M, El-Raziky MS, Abdel-Hamid M, Saad Y, Hashem M, Zakaria S, Mohamed MK, Esmat G. Impact of past HBV exposure on virological response to combined interferon ribavirin therapy in patients with chronic HCV genotype 4. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ojim.2011.12010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Zakaria S, Fouad R, Shaker O, Zaki S, Hashem A, El-Kamary SS, Esmat G, Zakaria S. Changing Patterns of Acute Viral Hepatitis at a Major Urban Referral Center in Egypt. Clin Infect Dis 2007; 44:e30-6. [PMID: 17243045 DOI: 10.1086/511074] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 10/19/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Changes in the viral etiology of hospitalized patients can inform us of changes in the overall epidemiology of acute viral hepatitis infections. We hypothesized that improvements in health care and sanitation in the past 2 decades in Egypt have significantly impacted the viral causes of acute viral hepatitis in hospitalized patients. We compared the viral causes of acute viral hepatitis at a major urban referral center with results reported from the same center 20 years earlier. METHODS Over a period of 10 months, 200 consecutive inpatients with clinical acute viral hepatitis were enrolled in the study, and serum samples were tested for hepatitis A through E, cytomegalovirus, and Epstein-Barr virus. RESULTS The frequency of acute hepatitis B virus infection as a cause of symptomatic hepatitis decreased from 43.4% in 1983 to 28.5% in 2002 (P<.01), and acute hepatitis A virus infection increased from 2.1% in 1983 to 34% in 2002 (P<.01), and occurred at older ages. In 1983, non-A, non-B hepatitis virus infection caused acute viral hepatitis in 38.7% of cases, compared with 31% in the present study (P=.12). The mean alanine aminotransferase level was highest in patients with combined infections, and clinical presentation did not distinguish between different viral etiologies of hepatitis. CONCLUSIONS A significant decrease in hepatitis B virus infection and an increase in hepatitis A virus infection have occurred since the earlier study was performed in 1983. The decrease in hepatitis B virus infection is attributable to the steep decrease in hepatitis B virus infection among children that resulted from the universal hepatitis B virus immunization of infants that was initiated in 1991. The increase in clinical hepatitis A virus infection occurred in older patients and could be attributed to improved sanitation that delayed individuals' initial exposures to the virus.
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Affiliation(s)
- Soheir Zakaria
- Department of Tropical Medicine, Cairo University, Al-Azhar University, Cairo, Egypt
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10
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El Gaafary MM, Rekacewicz C, Abdel-Rahman AG, Allam MF, El Hosseiny M, Hamid MA, Colombani F, Sultan Y, El-Aidy S, Fontanet A, Mohamed MK. Surveillance of acute hepatitis C in Cairo, Egypt. J Med Virol 2005; 76:520-5. [PMID: 15977225 DOI: 10.1002/jmv.20392] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Surveillance of acute hepatitis has been set up in two fever hospitals in Cairo to diagnose acute hepatitis C. Patients were categorized as definite acute hepatitis C with positive hepatitis C virus (HCV) RNA and without anti-HCV antibody, or probable acute hepatitis C with positive HCV RNA, positive anti-HCV antibody, alanine aminotransferase >/=4 times the upper limit of normal (ULN), and high risk parenteral exposure in the 1--3 months prior to the beginning of symptoms. From May to November 2002, 315 patients were recruited in the study. Of these, 115 (36.5%) had acute hepatitis A, 89 (28.3%) had acute hepatitis B, and 111 (35.2%) had non-A non-B acute hepatitis. Of the total with complete data (n=309), 12 (3.9%, 95% CI=2.0%-6.7%) had definite acute hepatitis C, and 11 (3.6%, 95% CI=1.8%-6.3%) had probable acute hepatitis C. In patients with definite acute hepatitis C, dental exposure (n=5) and intravenous drug use (n=2), were the only high risk procedures found in the 6 months prior to diagnosis. Five patients had no identifiable parenteral exposure. In conclusion, results from this study suggest that acute hepatitis C can be diagnosed by surveillance of acute hepatitis in hospital settings in Cairo and that minor community exposures contribute substantially to local HCV transmission.
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Affiliation(s)
- Maha M El Gaafary
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Derbala M, Amer A, Bener A, Lopez AC, Omar M, El Ghannam M. Pegylated interferon-alpha 2b-ribavirin combination in Egyptian patients with genotype 4 chronic hepatitis. J Viral Hepat 2005; 12:380-5. [PMID: 15985008 DOI: 10.1111/j.1365-2893.2005.00604.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Egypt has a high prevalence rate of hepatitis C (HCV) infection and as much as 90% is genotype 4. Response to interferon (IFN) varies with viral genotype and degree of fibrosis. Genotype 4 is poorly sensitive to standard IFN and IFN-ribavirin combination. We evaluated pegylated interferon (PEG-IFN)-alpha2b in our patients. Sixty-one patients with compensated chronic HCV genotype 4 were enrolled in two groups: group A (31 patients) received IFN-alpha2b 3 MU three times per week and group B (30 patients) received 1.5 mug/kg PEG-IFN-alpha2b once weekly. Ribavirin was added to each regimen in a dose of 800-1200 mg based on body weight. Patients were followed up for 24 weeks to assess the sustained response (SR). End-of-treatment response (ETR) was achieved in 11 of 31 patients (35.48%) in group A, and 13 of 30 patients (43.33%) in group B (P < 0.05). Only eight patients in group A and 10 in group (B) achieved a sustained virological response (25.8 and 33.3%, respectively) (P < 0.05). By computing ETR, SR or relapse and pretreatment baseline data (pretreatment, viral load, alanine transaminases, necroinflammatory and hepatic fibrosis), both inter- and intragroup, no significant correlations could be detected. In terms of safety and tolerability, PEG-IFN-alpha2b and IFN-alpha2b were comparable. In spite of mild insignificant increase in ETR and SR with the pegylated form, the poor response of genotype 4 in Egypt (genotype 4a) to different forms of IFNs may be related to an intrinsic resistance to the direct antiviral effect of IFN.
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Affiliation(s)
- M Derbala
- Department of Gastroenterology, Hamad Medical Corporation, Doha, Qatar.
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12
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Dokić M, Begović V. [Therapy of acute hepatitis C infection]. VOJNOSANIT PREGL 2005; 62:247-9. [PMID: 15790055 DOI: 10.2298/vsp0503247d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hepatitis C viral infection is a major cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. The progression of acute to chronic infection occurs in 50-90% of cases. There is no standard therapy for acute HCV infection. Comparative studies are required to verify the optimal doses, dosage schedules and the treatment duration, and to establish the optimal treatment for acute hepatitis C. Recent reports have demonstrated that early application of interferon alpha was a treatment of choice for acute HCV infection. The addition of ribavirinin in the treatment of acute HCV infection, and HCV genotype, did not improve the end-of-treatment responses. It is important to consider the treatment of acute HCV infection before it progresses to chronic state. CASE REPORT Beneficial effect of interferon therapy in a patient with acute hepatitis C is presented. Early treatment with 3 MIU interferon alpha, three times a week, within six-months, resulted in the normal serum aminotransferases, and good virological response in our patient. CONCLUSION Interferon therapy significantly increased the probability of obtaining normal serum aminotransferases and undetectable HCV RNA, following acute HCV infection.
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Affiliation(s)
- Milomir Dokić
- Vojnomedicinska akademija, Klinika za infektivne i tropske bolesti, Beograd
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Frank C, Mohamed MK, Strickland GT, Lavanchy D, Arthur RR, Magder LS, El Khoby T, Abdel-Wahab Y, Aly Ohn ES, Anwar W, Sallam I. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet 2000; 355:887-91. [PMID: 10752705 DOI: 10.1016/s0140-6736(99)06527-7] [Citation(s) in RCA: 667] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The population of Egypt has a heavy burden of liver disease, mostly due to chronic infection with hepatitis C virus (HCV). Overall prevalence of antibody to HCV in the general population is around 15-20%. The risk factor for HCV transmission that specifically sets Egypt apart from other countries is a personal history of parenteral antischistosomal therapy (PAT). A review of the Egyptian PAT mass-treatment campaigns, discontinued only in the 1980s, show a very high potential for transmission of blood-borne pathogens. We examine the relative importance of PAT in the spread of HCV in Egypt. METHODS The degree of exposure to PAT by cohort was estimated from 1961-86 Ministry of Health data. A cohort-specific exposure index for PAT was calculated and compared with cohort-specific HCV prevalence rates in four regions. FINDINGS HCV prevalence was calculated for 8499 Egyptians aged 10-50 years. A significant association between seroprevalence of antibodies to HCV and the exposure index (1.31 [95% CI 1.08-1.59]; p=0.007) was identified across four different regions. In all regions cohort-specific HCV prevalence was lowest in children and young adults than in older cohorts. These lower prevalence rates coincided with the gradual and final replacement of PAT with oral antischistosomal drugs at different points in time in the four regions. INTERPRETATION The data suggest that PAT had a major role in the spread of HCV throughout Egypt. This intensive transmission established a large reservoir of chronic HCV infection, responsible for the high prevalence of HCV infection and current high rates of transmission. Egypt's mass campaigns of PAT may represent the world's largest iatrogenic transmission of blood-borne pathogens.
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Affiliation(s)
- C Frank
- University of Maryland, School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore, USA.
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Abstract
Chronic hepatitis C is the leading cause of liver-related morbidity and mortality in the Western world. Treatment response in the chronic phase of the disease is still unsatisfactory. Acute hepatitis C takes a chronic course in more than 50% of cases. Interferon therapy treatment in the acute presentation phase is, according to some studies, more efficient than in the chronic phase of disease. The aim of this study was to analyse the response to interferon in acute hepatitis C. This review is based on three published meta-analyses performed using the methods of DerSimonian and Laird. Outcome was assessed by normalisation of serum aminotransferases and clearance of HCV-RNA. Data were presented by calculating the risk difference, which estimated efficacy by calculating the proportion of patients in treatment groups who responded better (0 to 1.0) or worse (0 to -1.0) than untreated control groups. Three mega units of interferon-a2b (IFN) three times a week for 6-24 weeks produced a significant response as measured by long-term normalisation of aminotransferases and clearance of HCV-RNA. Overall rate differences were +0.31 (p<0.01; 95% confidence interval +0.19-0.43) and +0.33 (p<0.001; 95% confidence interval +0.08-0.58). Six MU of IFN three times a week for 16-24 weeks produced better results with a risk difference of +0.53 (95% confidence interval +0.17-0.89) for normalisation of aminotransferases and +0.44 (95% confidence interval +0.06-0.82) for clearance of HCV-RNA. In an uncontrolled trial, 10 MU IFN daily for 4-6 weeks produced clearance of HCV-RNA and normalisation of transaminases in 90% of patients. Twelve weeks' treatment of symptomatic acute hepatitis C with interferon produced a response similar to that of long-term treatment for chronic hepatitis C. More studies are needed to define the role of a higher dose and the start of treatment.
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Affiliation(s)
- W Vogel
- Department of Gastroenterology and Hepatology, Innsbruck University.
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Kamal SM, Madwar MA, Peters T, Fawzy R, Rasenack J. Interferon therapy in patients with chronic hepatitis C and schistosomiasis. J Hepatol 2000; 32:172-4. [PMID: 10673085 DOI: 10.1016/s0168-8278(00)80207-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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