Prevalence of hepatitis C virus among bilharziasis patients

Hepatitis C virus [HCV] infection with concurrent Schistosoma mansoni infestation has emerged as a major cause of chronic liver disease and liver cirrhosis. The aim of this study was to investigate the prevalence of HCV among bilharzia patients. The study was conducted at the Viral Diagnostic and Parasitology Departments, Regional Laboratory and Blood Bank, Dammam, Kingdom of Saudi Arabia from August 1999 to July 2000. Sera from a total of 405 patients, including 356 Saudi nationals and 49 non-Saudis, who had a clinical suspicion of bilharziasis were tested, using enzyme linked immunosorbent assay for HCV infection and indirect hemagglutination tests for Schistosoma infestation. Diagnosis of schistosomiasis was made when serum anti-schistosoma antibody titer was either equal to or more than 1:256. A total of 39 cases out of 405 tested positive for bilharzia antibodies comprising of 22 [44.9%] non-Saudi and 17 [4.8%] Saudi individuals. Among these patients 7[17.9%] were found to have evidence of HCV infection. Of the 7 patients tested positive for HCV antibodies, there were 4 [26.7%] Egyptians, 2 [11.8%] Saudis and one [14.3%] Middle-Eastern. Our data shows that a good proportion [17.9%] of patients with bilharziasis had HCV infection. The percentage positive for HCV antibody were 26.7% in Egyptians, which is higher when compared to other nationals and Saudis

Incidence of hepatitis B and C among bilharzial school children in a rural area

This work was done on 96 children, 72 children were infected with schistosomiasis as proved by Schistosoma ova in their rectal snips and 24 children as control with no Schistosoma ova in their rectal snips. All the studied cases were subjected to a screen test for hepatitis B surface antigen [HBSAg] and a screen test for hepatitis C antibodies [anti-HCV] by ELISA. The screen test for HBSAg was positive in 13 patients, while was positive in two cases of the control group with a significant difference. The screen test for HCV antibodies was positive in 15 patients, while was positive in one case of the control group with a significant difference. Combined infection [HBSAg positive and HCV antibody positive] was found in eight patients, while no combined infection was found in the control group

Schistosomiasis as a possible risk factor for acquiring hepatitis C virus [HCV] infection among Saudis

Risk factors for acquiring hepatitis C virus [HCV] infection have been elucidated in many developed countries but the picture is still not clear in many Middle Eastern Countries including Saudi Arabia. Aim-To investigate possible risk factors for acquiring HCV among Saudis. Methods-Various demographic and medical risk factors that might be associated with the spread of HCV among Saudis were investigated. The population studied included 20 anti-HCV-positive with chronic liver disease [CLD], 30 anti-HCV-positive patients without CLD and 272 anti-FICV-negative Saudi blood donors. All people investigated were of the same age group [>40 years of age]. Results-None of the demographic parameters studied [type of job, type of housing, education] was found to be significantly associated with acquiring HCV infection among our Saudi patients, On the other hand up to 40% of the anti-Hey-positive patients and irrespective of the condition of liver disease had a history of surgery, and 25% of them had a history of multiple injections. Furthermore, at least 20% of our anti-HCV-positive patients had a history of schistosomiasis which is significantly higher than schistosomiasis among the blood donors [Pc0.005]. Conclusion-In addition to blood and blood products, schistosomiasis seems to be a possible risk factor for acquiring HCV among the Saudi population. The association between schistosomiasis and enhancement of HCV infection need to be further elucidated

Study of the risk factors for viral hepatitis C infection among Egyptians applying for work abroad

The aim of this study was to identify the risk factors for viral hepatitis C infection among Egyptians. A cross-sectional study with case control analysis was conducted including 5071 Egyptians applying to the Ministry of Health Laboratories for certification of freedom from viral hepatitis [B and C] to work abroad. A questionnaire designed to cover the most important known and suspected risk factors was filled out by physicians interviewers before blood drawing and after proper orientation of the purpose of the study. The overall seropositivity among the whole sample for HCV was 31.5% and was significantly lower among females [13.2%] than among males [34%]. A consistent increase of seropositivity for HCV antibodies with age [in males and females and in urban and rural areas] was observed with a peak level of 54.9% in all individuals for the age group 45-49 years [significant trend p < 0.0001] A significant increase of seropositivity [p < 0.005] above 25 years of age [35.7%] than below this age 12.8%] was observed on examination of HCV distribution in 5-year age group. Married individuals have a significant higher seropositivity for HCV than non-married [38.2% and 20.9% respectively OR=2.3, 95%CL 2.1-2.7]. Individuals living in rural areas had significantly more HCV seropositivity than those living in urban areas [OR=1.7, 95% CL 1.5-2.0]. Also, individuals living in Cairo and seashore governorates had significantly lower seropositivity [14.7% and 12.7% respectively] than those living in governorates in upper or lower Egypt [29.4% and 36.3% respectively]. Medical procedures risk factors identified to be associated with significant higher HCV seropositivity included: past history of injections for bilharziasis, use of common syringes dental extraction, injections for urography, blood transfusion and previous hospitalizations. Multivariate logistic analysis revealed that only age, male sex, marriage, rural residence, living in upper and lower Egypt, injections for bilharziasis and urography were significant in the final equation for the whole group Blood transfusion was significant in the final regression analysis among females in urban living and hospitalization was significant among males in urban living and females in rural living. Further research is needed to elucidate those factors prevailing in rural areas and in upper and lower Egypt associated with increased risk for HCV infection

Viral hepatitis C infection among Egyptians: the magnitude of the problem: epidemiological and laboratory approach

This study examines the relative importance of risk factors for viral hepatitis C infection and estimates the magnitude of HCV problem among Egyptians. It is a continuation of a recently performed cross-sectional study conducted on more than 5000 Egyptians. Serum samples [1945] were analyzed for liver enzymes [SGPT and SGOT] to evaluate the status of liver affection. One hundred and sixty nine samples [103 confirmed HCV seropositives and 66 seronegative] were analyzed for PCR HCV RNA to estimate the frequency of HCV viraemia among those individuals. Rates for HCV seropositivity by ELISA test in mass screening were corrected using predictive value of a positive test at prevalence between 5-50%. Attributable risk and population attributable risk estimates were calculated for those significant factors in logistic regression analysis. Overall number of HCV infected individuals was estimated for age groups of 15-65 years and the numbers of HCV related liver complications were estimated. HCV PCR RNA was positive for 50% of ELISA-seropositive samples and for 13.8% of the seronegative samples. However, only 5% of those individuals with HCV seropositivity and 3.7% of those with PCR RNA positivity Showed SGPT serum levels above 1.5 normal. The overall age, sex and urban/rural adjusted rate of true HCV seropositivity is estimated to be 15.6% among working Egyptians between 15-65 years. Attributable risk due to injections for the treatment of bilharziasis is estimated to be 47% [95% CL=38%-55%] among exposed males. Blood transfusion was estimated to be responsible for 87% [95% CL=57%-96%] of cases among previously transfused females. Population attributable risk for injections for treatment of bilharziasis among working urban and rural males is estimated to be 15% and 11% respectively. Blood transfusion and sharing contaminated needles contributed by 24% of cases [for each] among working urban females. Previous hospitalization contributed by 36% of cases among working rural females and by 10% among working urban males. As for the national estimate of cases of HCV seropositivity we estimated more the 5 million individuals with an expected number of chronic hepatitis of varying degrees of 3.5 millions. HCV viraemia with high probability for transmission is present in more than 50% of those individuals and liver cirrhosis cases expected to develop within an average of 20 years of infection are in the range of 350-700 thousand cases. The major proportions of population attributable risk are due to other undefined risk factors associated with age, male sex, living in rural areas and in lower and upper Egypt. Further research is needed to elucidate those factors prevailing in these areas, associated with increased risk of HCV infection

Study of the high prevalence of HCV in Egypt

The correlation of schistosomiasis and other variables as a risk factor behind the remarkable high rates of HCV seropositivity in Egypt was studied by examining the sera of 188 subjects [94 apparently healthy villagers and 94 non professional blood donors] for Schistosoma antibodies by Falcon assay screening test enzyme linked immunosorbent assay [FAST-ELISA] and for HCV antibodies by the application of screening [ELISA] and confirmatory [RIBA] techniques The results showed that the overall prevalence of HCV antibodies was 29.8% by ELISA reduced to 21.8% i.e. 73.2% confirmation by RIBA test. HCV-RNA [HCV viraemia] was detected in 76% of 25 ELISA anti-HCV positive sera by P.C.R. technique. After adjustment for age, there was no statistical significant correlation between the remarkable high rates of HCV seropositivity in Egypt and risk factors studied other than blood transfusion, and schistosomiasis

Transfusion associated hepatitis in patients with schistosomiasis

The study population [208 subjects] was divided into four groups in relation to the risk of blood transfusion. Schistosomal patients comprised two groups; one with previous history of blood transfusion [n: 61] and the other gave no history of past exposure to transfusion [n: 50]. Non schistosomal subjects included 42 patients with history of repeated transfusion and 55 healthy controls with no apparent parenteral risks. Hepatitis markers B, D and C were assayed using enzyme immunoassay [EIA]. Serum samples reactive by HCV EIA were further tested with recombinant immunoblot assay [RIBA-2]. A significantly higher HB carrier state [positive HBs Ag] was observed among the schistosomol group whereas, markers of previous exposure to HBV [anti-HBs, total anti Hbc and anti-HBe] were not significantly different among schistosomal groups and transfused non schistosomal ones, yet they differed significantly from the healthy controls. Anti-HCV seroprevalence was significantly higher among schistosomal and transfused non-schistosomal groups than the control group with a recorded good correlation between second generation EIA and RIbA tests. Schistosomiasis is believed to be a potent risk factor for HB and HCV infection and is comparable to the risk of transfusion. It is also considered to be a major cause of persistance and superinfection with hepatitis virus infection

Clinical assessment of chronic hepatitis C associated with bilharzial liver, 2 years follow-up study

Forty bilharzial patients were subjected to this study. All had hepatitis C virus antigenemia in their blood. They were grouped into two groups. Group I subjected ribavirin therapy for 9 months. Group II receive symptomatic and supportive treatment. Improvement of transaminases blood levels were noticed in all patients of group I, while, an increase in serum bilirubin was noticed. Ascites developed in 2 patients, one during treatment and the other just at the end of it. Depressive mood developed in 3 cases, especially late in the course of antiviral therapy. Non-specific symptoms already were present and showed no improvement, even generalized bony-ache, fatigue and insomnia were increased in patients of group I. Viral antigenemia disappeared in 20% of group I patients after therapy, but relapse occurred in half of that percentage during the 1st year and all were relapsed again by the end of that 1st year after recovery

Prevalence of antibodies to hepatitis C virus in patients with chronic liver disease

The prevalence of antibodies to hepatitis [C] virus [anti-H C V] has been measured by ELISA test in 87 bilharzial patients with chronic active hepatitis, [C A H], 42 bilharzial patients without C A H and 30 non-bilharzial patients. Antibodies to H C V were detected in 52.87% of bilharzial patients with CAH, 19.05% of bilharzial patients without C A H and 13.33% of non-bilharzial patients, respectively. The differences between these prevalence rates were statistically significant. All the 58 anti-H C V positive samples were retested by RIBA test, and 51 samples [87.93%] were still positive. By comparison, 21 bilharzial patients with C A H, [24.14%], 6 bilharzial patients without CA H, [14, 29%] and 3 non-bilharzial patients [10%] were HBsAg positive

Prevalence, impact and risk factors of hepatitis C infection

The present study was designed to investigate the status of hepatitis C virus [HCV] infection and associated risk factors among Egyptian military recruits. The impact of HCV infection on liver function was also assessed. The sera of 726 military recruits were tested for HCV antibodies using second generation ELISA technique [Ortho]. The overall prevalence was 330.4%. Considering the presence of hepatitis B and/or schistosomiasis infection, HCV antibodies were detected in 30.0% of HBsAg carriers, 36.8% of bilharzial patients and 48.8% of those with concomitant infections. Among individuals without schistosomiasis or HBV infection, the rate decreased to 22.5% positive with HCV. The present study indicated that parenteral exposure to the virus might be the most important route for acquiring infections while blood transfusion had a very minor role. The study of the impact of HCV on liver functions revealed that a single infection with HCV only was associated with almost normal liver function tests. However, infection with more than one hepatitis virus revealed a greater impact on the liver function. Morbidity also increased when schistosomiasis infection was superimposed

effects of praziquantel administration on the course of hepatitis B among cases with concomitant schistosome infection

The present work was designed to study the course of HB virus infection among bilharzial and non-bilharzial patients and to assess the therapeutic effect of praziguantel administration on subsequent course of HB among individuals with concomitant infections. This study included 26 bilharzial. cases, 14 cases with HB and 40 cases with both infections [HB and schistosomiasis]. Praziquantel was administered to all bilharzial positive cases. Sera were Collected from all groups prior to antibilharzial chemotherapy, and then later at three and six months post treatment. The results show improvement of both liver function tests and cell mediated immunity as estimated by increased mean value of CD[3], CD[4], helper/suppressor ratio among individuals who received praziquantel in the two groups with schistoscmiasis and concomitant infection. Furthermore the individuals who lost their HB surface antigenaemia were found to have a higher mean pan T cells, CD[4] values, normal helper/suppressor ratio and absence of C1C in their sera than those who retained their carrier state. The follow up of HB carriers demonstrated a higher cure rate [clearance of HBsAg] among the group with concomitant infection as compared to the group with virus hepatitis only. RBV type two infection was common among the study population accounting for 25.9% of HBsAg positive cases. 42.9% of them cleared their antigeneamia after treatment with praziquantel