Hepatitis C virus infection at Sharkia Governorate, Egypt: seroprevalence and associated risk factors.

Because many persons with chronic hepatitis C virus (HCV) infection are asymptomatic, population based serologic studies are needed to estimate the prevalence of infection and to develop and evaluate prevention efforts. A sample of 1422 individuals was included in the study by using multistage sampling technique. Their age ranged from 4-78 years with a mean age (34.7 +/- 18.5), 782 were males (55%) and 640 were females (45%). Exposures and demographic characteristics were obtained through a predesigned questionnaire. Antibody to HCV was assessed using micro-particle enzyme immunoassay (MEIA) enzyme assay by IMX, and the HCV RNA was tested by Real-time PCR technique using ABI Prism 7700 system. The seroprevalence of antibodies to HCV were 23.4% and 27.4% in urban and rural areas respectively, with an overall prevalence (25.8%). This reflects prior HCV infection but not necessarily a current liver disease. Prevalence was higher among males than females and increased sharply with age, from 4.8% in those < 20 years old to (41.9%) in older ages (> or = 40 years). Those who were not educated and farmers had a significantly high prevalence. The significant predictors of HCV infection were previous parenteral therapy for schistosomiasis (OR = 4.3, 95% CI = 3.6-7.9), among those over 20 years of age (3.5, 2.18-5.8), blood transfusion (4.1, 2.4-6.9), invasive procedures (surgery and endoscopy), and use of contaminated syringes and needles. Also, shaving at community barbers added significance to the model. Exposures not significantly related to HCV seropositivity were gender, active infection with Schistosoma mansoni, sutures or intravenous and urinary catheterization, water pipe "goza" smoking in group.

Autoantibodies in HCV infected patients at Sharkia Governerate, Egypt.

It is not clear whether HCV induces an autoimmune disease in infected patients or not. The aim of this study is to evaluate some immunological manifestations in chronic heapatitis C patients and to find out its relationship to liver pathology. The study included 109 positive HCV-RNA patients. They were classified according to liver histopathology into three groups: Group I included 22 patients (G1S1), Group II included 67 patients (G2S2) & Group III included 20 patients (G3S3), where G=The degree of necro-inflammatory process & S=Stage of liver fibrosis. All patients were investigated for the presence of: cryo-globulin, anti-neutrophil cytoplasmic (ANCA), anti-liver kidney microsomes (LKM), anti-double stranded DNA, (ds-DNA), anti-nuclear (ANA), anti-mitochondrial (AMA) and anti-smooth muscle (ASMA) auto-antibodies. The following results were obtained: ANCA, LKM, ds-DNA, ANA, ASMA, AMA and cryoglobulin were detected in 83/109 (76.1%), 32/109 (29.4%), 23/109 (21.1%), 38/109 (34.9%), 25/109 (22.9%), 5/109 (4.6%) and 60/109 (55%) of chronic HCV respectively. A highly significant positive correlation was found only between ANCA auto-antibodies and cryoglobulin versus grades of liver cirrhosis. Using ANCA, cryoglobulin, age and gender as covariates and by logistic regression analysis, Odds ratio (OR) revealed that these covariates were significant predictors of cirrhosis that add significance to the model according to the sequence: ANCA, cryoglobulin, age and gender suggesting that these covariates associate significantly with development of cirrhosis in HCV patients and that they are significant predictors of liver cirrhosis in HCV patients. The high prevalence of autoantibodies in chronic HCV patients suggests that HCV may trigger an autoimmune reaction, but most probably do not indicate a distinct autoimmune mechanism. Cryoglobulins and ANCA may be a useful prognostic indicator for increased risk of cirrhosis in chronic HCV patients. Follow up studies are recommended.

Haematologial manifestations in HCV infected patients at Sharkia Governerate, Egypt.

Hepatitis C virus (HCV) is a major cause of morbidity worldwide. The aim of this study is to evaluate hematological manifestations occurring in patients suffering from chronic HCV infection. Positive HCV-RNA cases (109) were subjected to the following C.B.C., P.T., P.T.T., B.T., C.T., detection of F.D.Ps., measurement of plasma AAT then B.M. aspiration and examination for 20 cases of them. Patients were classified into 3 groups according to the histopathological staging and grading of liver biopsy. Comparison between groups according to histopathological grading and staging for hematological and chemical parameters revealed significant statistical difference in platelets count, S. Albumin, ALT and AST levels. Comparison between groups according to histopathological grading and staging for coagulation profile, AAT level and FDPs revealed significant statistical difference regarding all parameters. Bone marrow aspiration and examination revealed mild hypocellularity with increased number of lymphocytes and relevance of plasmacytoid-lymphocytes. From this study we can conclude that patients with chronic HCV infection are in need for good observation and follow up before taking therapy because they have some hematological abnormalities which need more concern in order to decrease their progressive effect before starting therapy for HCV per se. They should be always screened and given liver and marrow supportive supplements.

HCV and associated concomitant infections at Sharkia Governorate, Egypt.

The natural history of hepatitis C virus (HCV) infection has a highly variable course. Many patients develop chronic infection, with its consequent risk of cirrhosis, liver failure and hepatocellular carcinoma. A key question is whether patients at high risk of disease progression can be distinguished from those with relatively benign disease course. The disease progression is influenced by other factors such as duration of infection, age at infection, sex, co-infection with hepatitis B virus (HBV), Epstein Bar virus (EBV), cytomegalovirus (CMV), the level of HCV viraemia and its type. Other endemic infections in the community as bilharziasis may have a role in progression of the condition to serious complications. These factors are correlated with newly proposed grades and stages of the disease. The studied (109) cases were divided into 6 groups according to the concomitant infection with HCV. The result proved that groups 1, 3 & 5 had a higher level of viraemia than other groups, and to be the high-risk groups as 56.4% and 34.6% were in G2S2 and G3S3, respectively. All cases of liver cell dysplasia and hepatocellular carcinoma in this study were seen in these groups. The conclusion showed that these factors play an important role in the progression of HCV infection. Death of the patients of this progressive condition occurs in younger age and is more due to liver failure than to HCC.

Non-invasive markers and predictors of severity of hepatic fibrosis in HCV patients at Sharkia Governorate, Egypt.

Liver biopsy is thought mandatory for management in patients with hepatitis C virus infection (HCV) especially for histopathological grading and staging of the disease to assess suitability for treatment and monitoring disease progression. However, tracking of liver disease progression can't rely on repeated biopsies. The study aimed to evaluate two significant items, we try to develop and validate a non-invasive predictive tool to assess hepatic necro-inflammation and fibrosis. Also, to determine factors that associate severity of hepatic pathology in HCV infected Egyptian patients particularly at Sharkia G. The study included 109 patients with detectable HCV by Real Time-PCR. The patients were classified into three different pathological stages and grades according to the new concept of histopathoglical staging and grading. The different clinical, biochemical, virological and ultra-sonographic parameters were assessed and analyzed and the variables that showed significant association with histopathological staging and grading were included in multivariate logistic regression analysis. The regression model revealed that, platelet count, matrix metalloproteinase-9 (MMP-9), portal vein diameter, splenic longitudinal axis, alanine transaminase, aspartate transaminase and viral load were the factors that add significance to the model in decreasing order of significance. From these findings we generate a new score ranged from 0-9. The score model was applied to our patients to assess its validity where it proved to be accurate in discriminating patients with mild inflammation and fibrosis (sensitivity 81.8%, specificity 80.5% and accuracy 80.7%) and more accurate in detecting patients with cirrhosis (specificity 96.6%, sensitivity 80% & accuracy 93.6%) but less accurate in detecting patients with moderate to severe fibrosis (specificity 66.7%, sensitivity 68.7% & accuracy 67.9%). Also the results revealed that, co-infection with schistosomiasis, old age > or = 45 years and positive history of blood transfusion as a source of infection was significantly associated with severe hepatic pathology. It is concluded that, the score model can't completely replace liver biopsy but at least it could be used to substantially reduce the number of liver biopsies done in patients with HCV infection in assessing disease progression during follow up. Also, it can be used to make decisions about treatment in patients who have contraindications to or who refused liver biopsy. Co-infection with schistosomiasis, age > or = 45 and positive history of blood transfusion in patients with HCV warrant special attention with more intensive follow up. These factors may play a major role in forecasting the course of HCV as well as in determining the therapeutic approach in each case.

The role of aflatoxin-contaminated food materials and HCV in developing hepatocellular carcinoma in Al-Sharkia Governorate, Egypt.

Aflatoxins, particularly aflatoxin B1 (AFB1) have been recognized as one of the most potent chemical carcinogen. In Egypt, HCV is prevalent. The progressive nature of HCV-related liver diseases was found to be influenced by other factors. In this paper, the role of aflatoxin contamination in the onset of liver cancer in HCV-infected patients was studied. The quantitative identification of the possible aflatoxins contamination in six urban and eleven rural areas using high performance liquid chromatography technique, revealed that corn, wheat, pea nut, lupine "termis", white rice, cowpea "lobiya", fava bean and brown rice showed the prevalence of AFB1 to be 64.7%, 53%, 53%, 47%, 47%, 41%, 29.4% & 29.4% respectively. A positive correlation was found between aflatoxin and positive HCV-PCR together with liver disease progression to G3S3, the indicative of hepatocellular carcinoma. Such correlation was not fully understood, but the oncogene amplification caused by HCV-infection may be aggravated by the consumption of aflatoxin contaminated raw food materials or their products.