community-based study of viral hepatitis infection in Giza Governorate, Egypt: Seroprevalence, risk factors and associated morbidity

ABSTRACT

Hepatitis viruses are major causes of acute and chronic liver diseases in Egypt. The aim of this study was to investigate the seroprevalence, risk factors and associated morbidity of viral hepatitis in Giza Governorate, Egypt. The study was conducted in 4 rural and 4 semiurban communities and included 2305 subjects selected by a cluster r and om method. They underwent complete clinical and abdominal ultrasonographic [US] assessment and laboratory tests including stool and urine examination, hemoglobin, ALT estimation and viral hepatitis markers by enzyme immunoassay. The latter included anti-HAV IgG, HBsAg, anti-HBc, anti-HBs, anti-HCV and anti-HEV IgG. Subsets of sera were tested for HBV DNA and HGV RNA by specific PCR. The overall prevalence of anti-HCV was 20.9% [age-adjusted prevalence = 24.5%; CI 22.7-26.3%] and was significantly rising with age from 10% below age of 20 years to 40% among those above 50 years. The infection rate of hepatitis B virus [HBV] was 57.1% with HBsAg carrier rate of 3.6%. Seropositivity of anti-HBs and anti-HBc was very high [45.8% and 44.7%, respectively] and correlated positively with age with no sex-related difference. Combined HCV and HBV infection was evident in 13% of subjects. HBV DNA was detected in 86% of HBsAg-positive cases and in 20% of HBsAg-negative anti-HBc- and anti-HCV-positive cases. Seromarkers for hepatitis B and C were significantly commoner in semiurban than in rural communities. Dental manipulation and previous parenteral antischistosomal therapy were significant risk factors for hepatitis B and C infection. Anti-HAV was positive in 99.7% whereas anti-HEV was positive in HBV= Hepatitis B virus. CLD = Chronic liver disease. HCC = Hepatocellular carcinoma. US = Ultrasonography. ALT = Alanine transaminase. OR = Odds ratio. CI = Confidence interval. 9.2%. HGV RNA was detected in 16.5% of the studied samples. It was always associated with HBV and /or HCV infection. History of hematemesis was recorded in 1.2% of individuals. US examination revealed hepatomegaly in 19.2% of subjects, splenomegaly in 8.2%, bright liver in 31%, coarse liver texture in 10%, periportal fibrosis in 20% and ascites in 2%. These findings were significantly more common in anti-HCV- and HBsAg-positive subjects. ALT elevation was commonest and highest in individuals with positive HBsAg or with HBV-HCV coinfection. Hepatitis B and C infection and associated morbidity still constitute a great health problem in Egypt. Hepatitis A is holoendemic and hepatitis E is endemic. Hepatitis G is always associated with HBV or HCV infection. Occult hepatitis B should be considered in future studies