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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: 0.9] [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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Sievert W, Altraif I, Razavi HA, Abdo A, Ahmed EA, Alomair A, Amarapurkar D, Chen CH, Dou X, El Khayat H, Elshazly M, Esmat G, Guan R, Han KH, Koike K, Largen A, McCaughan G, Mogawer S, Monis A, Nawaz A, Piratvisuth T, Sanai FM, Sharara AI, Sibbel S, Sood A, Suh DJ, Wallace C, Young K, Negro F. A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int 2011; 31 Suppl 2:61-80. [PMID: 21651703 DOI: 10.1111/j.1478-3231.2011.02540.x] [Citation(s) in RCA: 417] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The hepatitis C pandemic has been systematically studied and characterized in North America and Europe, but this important public health problem has not received equivalent attention in other regions. AIM The objective of this systematic review was to characterize hepatitis C virus (HCV) epidemiology in selected countries of Asia, Australia and Egypt, i.e. in a geographical area inhabited by over 40% of the global population. METHODOLOGY Data references were identified through indexed journals and non-indexed sources. In this work, 7770 articles were reviewed and 690 were selected based on their relevance. RESULTS We estimated that 49.3-64.0 million adults in Asia, Australia and Egypt are anti-HCV positive. China alone has more HCV infections than all of Europe or the Americas. While most countries had prevalence rates from 1 to 2% we documented several with relatively high prevalence rates, including Egypt (15%), Pakistan (4.7%) and Taiwan (4.4%). Nosocomial infection, blood transfusion (before screening) and injection drug use were identified as common risk factors in the region. Genotype 1 was common in Australia, China, Taiwan and other countries in North Asia, while genotype 6 was found in Vietnam and other Southeast Asian countries. In India and Pakistan genotype 3 was predominant, while genotype 4 was found in Middle Eastern countries such as Egypt, Saudi Arabia and Syria. CONCLUSION We recommend implementation of surveillance systems to guide effective public health policy that may lead to the eventual curtailment of the spread of this pandemic infection.
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Affiliation(s)
- William Sievert
- Monash Medical Centre and Monash University, Melbourne, Vic., Australia
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The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45:529-38. [PMID: 16879891 DOI: 10.1016/j.jhep.2006.05.013] [Citation(s) in RCA: 1775] [Impact Index Per Article: 98.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 05/03/2006] [Accepted: 05/16/2006] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS End-stage liver disease accounts for one in forty deaths worldwide. Chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are well-recognized risk factors for cirrhosis and liver cancer, but estimates of their contributions to worldwide disease burden have been lacking. METHODS The prevalence of serologic markers of HBV and HCV infections among patients diagnosed with cirrhosis or hepatocellular carcinoma (HCC) was obtained from representative samples of published reports. Attributable fractions of cirrhosis and HCC due to these infections were estimated for 11 WHO-based regions. RESULTS Globally, 57% of cirrhosis was attributable to either HBV (30%) or HCV (27%) and 78% of HCC was attributable to HBV (53%) or HCV (25%). Regionally, these infections usually accounted for >50% of HCC and cirrhosis. Applied to 2002 worldwide mortality estimates, these fractions represent 929,000 deaths due to chronic HBV and HCV infections, including 446,000 cirrhosis deaths (HBV: n=235,000; HCV: n=211,000) and 483,000 liver cancer deaths (HBV: n=328,000; HCV: n=155,000). CONCLUSIONS HBV and HCV infections account for the majority of cirrhosis and primary liver cancer throughout most of the world, highlighting the need for programs to prevent new infections and provide medical management and treatment for those already infected.
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Bashawri LAM, Fawaz NA, Ahmad MS, Qadi AA, Almawi WY. Prevalence of seromarkers of HBV and HCV among blood donors in eastern Saudi Arabia, 1998-2001. ACTA ACUST UNITED AC 2005; 26:225-8. [PMID: 15163322 DOI: 10.1111/j.1365-2257.2004.00601.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The prevalence of serological markers of HBV and HCV were determined for blood donors in eastern Saudi Arabia. Between 1998 and 2001, 13,443 donors (10,778 Saudi and 2665 non-Saudi), were screened for HBsAg, anti-HBc Ab, and anti-HCV Ab using commercial kits. There was a steady decrease in the HBsAg (2.58 and 1.67%), anti-HBc rates (15.32 and 9.15%), and anti-HCV (1.04 and 0.59%) rates between 1998 and 2001, respectively. However, there was a marked difference between Saudi and non-Saudi donors with regard to anti-HBc (P < 0.001) and anti-HCV (P < 0.01), but not HBsAg prevalence rates in the same time period.
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Affiliation(s)
- L A M Bashawri
- Department of Hematology, College of Medicine, King Faisal University, Dammam, Saudi Arabia
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5
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Abstract
The aim of the study was to analyse the current literature regarding the mode of transmission of HCV and its global prevalence in different groups of people. A systematic review of the literature on the epidemiology of hepatitis C from 1991 to 2000 using computerized bibliographic databases which include Medline, Current Content and Embase. The prevalence of hepatitis C virus (HCV) varies tremendously in different parts of the world, with the highest incidence in the Eastern parts of the globe compared with the Western parts. Furthermore, certain groups of individuals such as intravenous drug users are at increased risk of acquiring this disease irrespective of the geographical location. Although the main route of transmission is via contaminated blood, curiously enough in up to 50% of the cases no recognizable transmission factor/route could be identified. Therefore, a number of other routes of transmission such as sexual or household exposure to infected contacts have been investigated with conflicting results. Hepatitis C infection is an important public health issue globally. Better understanding of routes of transmission will help to combat the spread of disease. In order to prevent a world wide epidemic of this disease, urgent measures are required to (i) develop a strategy to inform and educate the public regarding this disease and (ii) expedite the efforts to develop a vaccine.
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Affiliation(s)
- M I Memon
- Department of Community Health, Guild NHS Trust, Lancashire Post Graduate Medical School, Preston, UK.
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6
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Lee CM, Lu SN, Changchien CS, Yeh CT, Hsu TT, Tang JH, Wang JH, Lin DY, Chen CL, Chen WJ. Age, gender, and local geographic variations of viral etiology of hepatocellular carcinoma in a hyperendemic area for hepatitis B virus infection. Cancer 1999; 86:1143-50. [PMID: 10506697 DOI: 10.1002/(sici)1097-0142(19991001)86:7<1143::aid-cncr7>3.0.co;2-z] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There are etiologic variations of hepatocellular carcinoma (HCC) in different geographic areas. Taiwan is a hyperendemic area for hepatitis B virus (HBV) infection. Hepatitis C virus (HCV) infection also plays an important role in HCC development in Taiwan. Identification of local HCV-endemic areas is important to keep HCV from spreading. This study investigated the etiologic variations of HCC in different geographic areas of Taiwan. METHODS The authors evaluated the hepatitis B surface antigen (HBsAg) and antibodies to HCV (anti-HCV) status of 284 patients (232 male, 52 female) with HCC. They also evaluated the gender ratio and mean age of these patients. RESULTS The mean age of HBsAg positive patients was significantly lower than the mean age of HBsAg negative patients (52.6 +/- 12.3 vs. 61.3 +/- 11.2 years) (P < 0.05). The male-to-female ratio was 4.5:1 for all HCC patients, 7:1 for HBsAg positive HCC patients, and 2.8:1 for anti-HCV positive HCC patients. In Chaiyi County in southern Taiwan, the prevalence of anti-HCV in male HCC patients was 52%, significantly greater than that of Taiwan as a whole (27.6%) (P = 0.07). However, the prevalence of anti-HCV in male HCC patients in Taipei County in northern Taiwan was 8.7%, significantly less than that of Taiwan as a whole (P = 0.043). Of a total of 65 Chiayi-based HCC patients, 55.4% were anti-HCV positive and 46.2% were HBsAg positive. In the Chiayi area, results of multiple logistic regression showed that the HCC patients who were age 60 years or older or who were living in the city area both had highly HCV-related disease. CONCLUSIONS The mean age of patients with HBV-related HCC was significantly lower than that of patients with non-HBV-related HCC. The male-to-female ratio for patients with HBV-related HCC was significantly higher than that of patients with HCV-related HCC. The authors identified an area of Taiwan in which HCV-related HCC was prevalent.
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Affiliation(s)
- C M Lee
- Liver Unit, Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Donato F, Boffetta P, Puoti M. A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma. Int J Cancer 1998; 75:347-54. [PMID: 9455792 DOI: 10.1002/(sici)1097-0215(19980130)75:3<347::aid-ijc4>3.0.co;2-2] [Citation(s) in RCA: 386] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of the study was to assess whether co-infection by hepatitis-B virus (HBV) and hepatitis-C virus (HCV) is associated with a higher risk of developing hepatocellular carcinoma (HCC) than each infection alone. A meta-analysis of data published up to June 1997 was performed. HBsAg and anti-HCV antibodies or HCV RNA (anti-HCV/HCV RNA) were considered as serological markers of current HBV and HCV infection respectively. A total of 32 case-control studies were suitable for a quantitative overview. The summary odds ratios (OR) were 13.7 for HBsAg positivity and 11.5 for anti-HCV/HCV RNA positivity. The OR for anti-HCV was lower among studies using second- or third-generation anti-HCV or HCV RNA (OR, 8.2) with respect to studies with first-generation anti-HCV test (OR, 19.1). When combining data from the studies with second- or third-generation anti-HCV or HCV RNA, the OR for HBsAg positivity and anti-HCV/HCV RNA negativity was 22.5 (95% confidence interval (CI), 19.5-26.0), the OR for anti-HCV/HCV RNA positivity and HBsAg negativity was 17.3 (95% CI, 13.9-21.6), and the OR for both markers positivity was 165 (95% CI: 81.2-374, based on 191 cases and 8 controls exposed). A synergism was found between HBV and HCV infections, the OR for co-infection being greater than the sum and lower than the product of those for each infection alone. The interaction was therefore negative according to the multiplicative model, providing epidemiological evidence both of an independent effect and of interference between the 2 viruses in the carcinogenic process.
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Affiliation(s)
- F Donato
- Cattedra di Igiene, Università di Brescia, Italy.
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Donato F, Boffetta P, Puoti M. A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma. Int J Cancer 1998. [DOI: 10.1002/(sici)1097-0215(19980130)75:3%3c347::aid-ijc4%3e3.0.co;2-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Altamimi W, Altraif I, Elsheikh M, Alkshan A, Qasem L, Sohaibani M. Prevalence of HBsAg and ANTI-HCV in Saudi blood donors. Ann Saudi Med 1998; 18:60-2. [PMID: 17341920 DOI: 10.5144/0256-4947.1998.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- W Altamimi
- Departments of Pathology and Laboratory Medicine, and Medicine, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Affiliation(s)
- F Z Al-Faleh
- Departments of Medicine, and Pathology, College of Medicine an d King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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11
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Frothingham R. Applications of the polymerase chain reaction to infectious disease diagnosis. Ann Saudi Med 1996; 16:657-65. [PMID: 17429255 DOI: 10.5144/0256-4947.1996.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- R Frothingham
- Infectious Disease Section, Durham Veterans Affairs Medical Center and Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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12
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Altraif I. Hepatitis C acquisition in Saudi Arabia: Are the majority of cases without risk factor? Ann Saudi Med 1995; 15:428-30. [PMID: 17590632 DOI: 10.5144/0256-4947.1995.428a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- I Altraif
- Consultant Hepatologist and Transplant Physician, Liver Transplant and Hepatobiliary Department, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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13
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Al-Karawi MA, Mohamed AE. Profile of cancer in Riyadh Armed Forces Hospital. Ann Saudi Med 1995; 15:424. [PMID: 17590626 DOI: 10.5144/0256-4947.1995.424a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M A Al-Karawi
- Gastroenterology Department, Armed Forces Hospital, Riyadh, Saudi Arabia
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Park BC, Han BH, Ahn SY, Lee SW, Lee DH, Lee YN, Seo JH, Kim KW. Prevalence of hepatitis C antibody in patients with chronic liver disease and hepatocellular carcinoma in Korea. J Viral Hepat 1995; 2:195-202. [PMID: 7489347 DOI: 10.1111/j.1365-2893.1995.tb00029.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To investigate the contribution of hepatitis C virus (HCV) to chronic liver disease and hepatocellular carcinoma (HCC) in Korea, antibodies to HCV (anti-HCV) were tested by enzyme immunoassay in 1759 patients with chronic liver disease and HCC, and in 808 healthy adults. The prevalence of anti-HCV was 1.6% in 808 controls. Anti-HCV was present in 32 (7.7%) of 418 hepatitis B surface antigen (HBsAg)-positive and 128 (53.1%) of 241 HBsAg-negative patients with chronic hepatitis, 16 (6.0%) of 265 HBsAg-positive and 90 (30.5%) of 295 HBsAg-negative patients with liver cirrhosis, and 16 (4.8%) of 330 HBsAg-positive and 61 (29.0%) of 210 HBsAg-negative patients with HCC. Antibodies to hepatitis B core antigen (anti-HBc) were present in 80-88% of patients who were seropositive for anti-HCV and seronegative for HBsAg. Among the sera from 114 patients with HBsAg-negative and anti-HCV-positive chronic liver diseases, HBV DNA and HCV RNA were detected by polymerase chain reaction (PCR) in 54 (47.4%) and 61 (53.3%), respectively. Both HBV DNA and HCV RNA were detected in 4 (4.4%) samples. The mean age of the patients with both HBsAg and anti-HCV was not different from that of patients who were seropositive for HBsAg alone. These findings indicate that current and/or past HBV infection is still the main cause of chronic liver disease in Korea.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B C Park
- Kosin Cancer Research Institute, Kosin University School of Medicine, Pusan, Korea
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Al Karawi MA, Ahmed AM, Yousuf M, Shariq S, Mohamed AE, Al-Jumah A. Alpha interferon in treatment of chronic hepatitis C viral infection (CHCV): Pilot study of 18 patients. Ann Saudi Med 1994; 14:464-6. [PMID: 17587949 DOI: 10.5144/0256-4947.1994.464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Eighteen patients with chronic hepatitis C virus infection (CHCV) were treated with three million units of interferon (IFN) three times a week for a minimum of six months. Four (22.2%) had completely responded, two (11.1%) had partial response and the rest (eight or 44.4%) did not show any evidence of response. After stopping treatment, patients who had a complete or partial response developed a relapse during the follow-up period. Few reversible adverse effects of treatment were reported in more than half of the patients. So, we conclude that three million units of IFN three times weekly is not recommended for treating patients with CHCV. Perhaps a larger dose of five to six million units should be tried and for a longer duration.
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Affiliation(s)
- M A Al Karawi
- Department of Gastroenterology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia
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16
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Abstract
In the short time that the hepatitis C virus has been known to be the major cause of parenterally acquired non-A, non-B hepatitis, it has become increasingly apparent that chronic infection with this virus is closely associated with the occurrence of hepatocellular carcinoma. Evidence for the link is provided mainly by case/control studies and case series but also by longitudinal studies. The proportion of patients with hepatocellular carcinoma who have circulating antibody to hepatitis C virus shows a pronounced geographical variation. In Japan, Spain, and Italy antibody is present in 47-83% of the patients, with relative risks of 52 (95% confidence interval 24-114) in Japanese and 69 (15-308) in Italian carriers of the virus. In regions where hepatitis B virus infection is endemic and is the major risk factor for hepatocellular carcinoma, antibody to hepatitis C virus is present in the serum of a smaller proportion (6-39%) of patients, with relative risks of 7 (1.6-39) in Taiwan and 6 (0.5-69) in Senegal. Comparatively low prevalences (13-35%) have also been recorded in the remaining geographical regions for which information is available, with relative risks of 10.4 (4-26) in Greece and 10.5 (3.5-31) in North America. There is some evidence for an interaction between hepatitis C and B viruses in hepatocellular carcinogenesis, but this remains to be proved. In most populations hepatocellular carcinoma develops at an older age in patients with hepatitis C virus-induced tumours than in those with hepatitis B virus-induced tumours. The pathogenesis of hepatitis C virus-related hepatocellular carcinoma is unknown. Because it always arises in association with cirrhosis or chronic hepatitis and because there is no evidence that the virus is directly carcinogenic, it appears that hepatitis C virus induces malignant transformation indirectly by causing chronic necroinflammatory hepatic disease which in turn is responsible for tumour formation.
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Affiliation(s)
- M C Kew
- Department of Medicine, Witwatersrand University, Johannesburg, South Africa
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Okuno H, Xie ZC, Lu BY, Qin X, Takasu M, Kano H, Shiozaki Y, Inoue K. A low prevalence of anti-hepatitis C virus antibody in patients with hepatocellular carcinoma in Guangxi Province, southern China. Cancer 1994; 73:58-62. [PMID: 7506119 DOI: 10.1002/1097-0142(19940101)73:1<58::aid-cncr2820730112>3.0.co;2-e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The incidence of hepatocellular carcinoma (HCC) in southern China, including Guangxi Province, is among the highest in the world. Investigations of the etiology of HCC in this area have focused on hepatitis B virus (HBV) and aflatoxin. However, hepatitis C virus (HCV) has been shown to be a possible pathogenic agent for HCC in a number of countries. METHODS Antibodies to HCV (anti-HCV), determined by second-generation enzyme immunoassay, and hepatitis B surface antigen (HBsAg) were assayed in the sera of 186 patients with HCC and 48 healthy control subjects from Guangxi Province in southern China. RESULTS HBsAg was detected in 131 (70.4%) of 186 patients with HCC, whereas only 10 (5.4%) patients were found to be positive for anti-HCV. The prevalence of anti-HCV in patients with HBsAg-positive HCC was 6.9% (9 of 131) and that in patients with HBsAg-negative HCC was 1.8% (1 of 55); there was no significant difference between these two groups. Anti-HCV was not detected in any of the healthy control subjects, in whom the prevalence of HBsAg was 10.4% (5 of 48). CONCLUSIONS These findings indicate that HCV does not seem to play an important role in the development of HCC in Guangxi Province; however, HBV infection appears to be a major pathogenic factor for HCC in this area.
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Affiliation(s)
- H Okuno
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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el Guneid AM, Gunaid AA, O'Neill AM, Zureikat NI, Coleman JC, Murray-Lyon IM. Prevalence of hepatitis B, C, and D virus markers in Yemeni patients with chronic liver disease. J Med Virol 1993; 40:330-3. [PMID: 8228926 DOI: 10.1002/jmv.1890400413] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A serological survey for hepatitis B, C, and D markers was carried out in the Yemen Republic. Serum samples from 243 pregnant females, 294 male blood donors, and 108 patients with chronic liver disease were examined. Hepatitis B surface antigen (HBsAg) was found in 18.5% healthy individuals and 24.1% patients with chronic liver disease (P = 0.03). Evidence of any marker for hepatitis B virus (HBV) infection was found in 59.8% healthy individuals and 75.9% of patients with chronic liver disease (P = 0.0016). HBeAg was detected in 32.1% of the HBsAg-positive pregnant females, indicating that vertical transmission probably plays a part in forming the pool of HBV carriers. Vaccination against HBV as part of the extended programme of immunisation (EPI) is recommended. Antibodies to hepatitis D were found in only 2 of 100 HBsAg-positive sera. Antibodies to hepatitis C (anti-HCV) were found in 2.1% healthy individuals and 21.5% patients with chronic liver disease (P = 0.0001). These results indicate that hepatitis B is hyperendemic in the Yemen Republic but that hepatitis D is very uncommon. The prevalence of anti-HCV is higher than in Europe and similar to neighbouring Arab countries. Infection with both HBV and HCV are important causes of chronic liver disease in the Yemen Republic.
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