Wide Sexual Dimorphism of Hepatocellular Carcinoma Presentation in Algeria

Hepatitis C in North Africa: A Comprehensive Review of Epidemiology, Genotypic Diversity, and Hepatocellular Carcinoma

Hepatitis C virus (HCV) is implicated in carcinogenic infections like hepatocellular carcinoma (HCC). Given that no HCV vaccine is currently available, comprehensive epidemiological understanding is crucial for devising effective prevention strategies. In North Africa, existing data on HCV infection and HCV-associated HCC are frequently outdated or limited to specific populations. This systematic review aims to offer new insights into the epidemiology of HCV infection, HCV genotype distribution, and HCV-related HCC in this region. We collected data from electronic databases: PubMed, ScienceDirect, ResearchGate, Google Scholar, and public health reports between 1989 and 2023. We reported the studies carried out in each country in general populations and in groups exposed to HCV infection. Our results show that HCV prevalence varies from 0.5% to 4.61% among the general populations in North African countries. HCV genotype 1 remains the most dominant in the Greater Maghreb region, while genotype 4 is the most dominant in the Nile Valley region. HCC incidence varies between the five countries, and HCV is responsible for 60% of cases, with male dominance. Egypt had the highest number of deaths from HCV-associated HCC. Other factors such as HBV, diabetes, and alcohol use are also responsible for HCC in North Africa. Urban growth and socioeconomic changes have impacted HCV prevalence in the North African region, especially among rural populations, and introduced new risks, such as coinfections and Type 2 diabetes. Here, we propose some recommendations for HCV control and management by patient category in North Africa.

Drastic sex-dependent etiological distribution in severe liver diseases from Gabon

Chronic liver diseases still represent a worrying public health issue in Sub-Saharan Africa. In this region, emphasis is generally made on hepatocellular carcinoma (HCC) albeit liver cirrhosis (LC) is also responsible for an important death toll. Very few studies have compared the presentation and etiologies of cancer and cirrhosis of the liver in Middle Africa. We conducted a comparative retrospective analysis of 74 and 134 cases of patients with HCC and LC treated in Libreville, Gabon. Viral or lifestyle risk factors, clinical symptoms, and biological features were compared. We observed that ages of diagnosis were 53.2 ± 15.7 years and 48.6 ± 18.6 years for HCC and LC with remarkably low M:F sex ratios (1.3–1.8). Ethanol consumption was highly prevalent in both disease types (65.0%–70.0%). Chronic viral infections with hepatitis B (HBV) or C (HCV) virus were also widespread with slight domination of the former in both diseases (43.4% vs. 34.3%, and 35.9% vs. 28.5%). Patients with HCC were presenting very late with a mean diameter of the main nodule of 84 ± 50 mm and a multifocal pattern in 72.7% of cases. HCC developed on a cirrhotic liver in 91.7% of cases. Serum AFP was frankly elevated (>400 ng/ml) in only 35.8% of HCC cases. The most striking feature of the HCC series was the contrasted contribution of distinct pathogenic etiologies involving sex, viral, metabolic, and toxic factors. A frequently dysmetabolic condition synergizing with hepatitis C (anti-HCV, 73.8% vs 22.7%, p < 0.0001) in females and a male cancer promoted by recreational toxicants and chronic hepatitis B (HBsAg, 83.5% vs 35.9%, p < 0.0001) were observed. Men with HCC were considerably younger than women (46.8 ± 14.5 years vs. 62.2 ± 12.2 years, p < 0.0001). Further studies are now warranted to identify routes of HCV transmission and if they are still fueling reservoirs of future patients. Public policies to prevent alcohol-related harm have also to be urgently implemented in Gabon.

Hepatocellular carcinoma in Senegal: epidemiological, clinical and etiological aspects about 229 cases at Hôpital Principal de Dakar

Hepatocellular carcinoma (HCC) is a major public health problem in Senegal, and the third most common cancer in terms of incidence. However, there are no recent data on the characteristics of this pathology in our country. The aim was to describe the epidemiological, clinical, aetiological and therapeutic aspects of HCC at Hôpital Principal de Dakar, Senegal. We did a descriptive retrospective study, including patients hospitalized from January 2012 to December 2017. We included 229 patients. The mean age was 47.4 years (21 - 88 years), and 77 patients (33.6%) were under 40 years of age. The sex ratio was 6.6. Twelve patients (5.2%) had a family history of 1st degree cirrhosis or HCC. Ten patients (4.4%) were previously treated with nucleotide analogues. The most common clinical sign at diagnosis was abdominal pain (91.7%). Alpha-fetoprotein level was normal in 12.2% of patients, and greater than 400 ng/ml in 68.1% of cases. Abdominal ultrasound found nodular HCC in 122 patients (68.2%), infiltrative HCC in 19 patients (10.6%), and was normal in 38 cases (21.2%). Subjacent cirrhosis was detected in 71.3% of cases. Abdominal computed tomography (CT) scan showed compatible HCC lesions in 88.8% of cases. A histological diagnosis was obtained in 2 patients (0.9%). The most common etiological factor was hepatitis B virus (69.4%), characterized mostly by a younger age (p = 0.001). In 20.9% of cases, no aetiology was found. An advanced or terminal stage (BCLC C/D) was found in 217 cases (94.8%). The treatment was curative in 12 patients (5.2%), and palliative in 7 cases (3.1%). The evolution at one year was favourable in 6 patients (2.6%). Hepatocellular carcinoma (HCC) is a disease that mainly affects young male adults in Senegal. The main aetiological factor remains HBV infection. The diagnosis is made at an advanced stage and the prognosis very bad.