Hepatocellular carcinoma in Egyptians with and without a history of hepatitis B virus infection: association with hepatitis C virus (HCV) infection but not with (HCV) RNA level.

Abstract

Abstract. The aim of this study was to analyze the association of hepatocellular carcinoma (HCC) with hepatitis C virus (HCV) in Egypt, using hepatitis B virus (HBV) and hepatitis E virus (HEV) as virus controls. In addition, the association of HCC with HCV RNA levels among persons seropositive for HCV was analyzed. We compared 131 patients with proven HCC, 247 with bladder cancer, and 466 healthy hospital employees. Age, sex, and place of residence were recorded to study confounding factors. Among the healthy controls, 16% were seropositive for HCV, 21% for HBV, and 31% for HEV. When healthy controls were age-matched with HCC patients, the latter were significantly (P Ͻ 0.001) more often HCV seropositive (67%) than were the controls (30%). The seropositivity for HBV and HEV did not differ significantly in frequency between the two groups. The seropositivity for HCV was also significantly (P Ͻ 0.001) more often found in HCC patients (76%) than in BC patients (47%), with seroprevalences for HBV and HEV not differing significantly in these age-matched groups. In HBV-negative HCC and bladder cancer patients, seroprevalence for HCV was significantly (P ϭ 0.002) higher in HCC patients (68%) than in bladder cancer patients (36%). This difference was even more pronounced (P Ͻ 0.001) in HBV-positive HCC and bladder cancer patients (78% versus 52%, respectively). Of HCV-seropositive individuals, 49% were HCV RNA positive by branched DNA assay, and of these, 96% were infected by HCV genotype 4. No correlation between HCV RNA load and seropositivity of HBV or age or disease state was found. Infection with HCV and HCV-HBV double infection, but not HBV or HEV infection alone, is strongly correlated with HCC in Egypt.Hepatitis C virus (HCV) causes more than 90% of parenterally transmitted non-A, non-B (NANBH) hepatitis.1-4 In more than 85% of HCV infections, the infection persists and leads to chronic hepatitis. 4,5 Once chronic hepatitis is established, it may slowly progress to worsening stages of fibrosis and cirrhosis and ultimately lead to the development of hepatocellular carcinoma (HCC). 1,[6][7][8] In the first two decades after acute HCV infection, both mortality and morbidity remain modest in frequency, but after this period both can be expected to increase.1,2 Infection with HCV is widely recognized as the most common indication for liver transplantation 9 in the United States, Europe, and Japan. Although no firm data are available, death rates for HCC in Egypt appear to be increasing over the last decade. 10,11 Hepatitis virus infections of any kind are highly prevalent in the general population. The relatively high prevalence of HCV infections in Egypt was first established in 1992 by Kamel and others. 12 Other groups thereafter found HCV seroprevalence rates ranging from 6% to 38% with an average of approximately 15%. [12][13][14][15][16] The reasons behind these high HCV infection rates being 5-35-fold higher than reported elsewhere in the world are still unknown. In Egypt, the HCV seroprevalence was 55% among ...

Epidemiologic risk factors of hepatocellular carcinoma in a rural region of Egypt

“…In Egypt, the independent effect of hepatitis virus in the etiology of HCC had been recognized earlier [16,26], as confirmed in our study. The strong association of cirrhosis and HCC was supported by the evidences of its intermediating role in the pathogenesis of HCC due to chronic viral hepatitis [14].…”

“…In terms of residential and occupational exposures, previous studies either treated residence as a confounder [26,27] or restricted their study in rural areas [12,14,15] given the fact that the prevalence of viral infection greatly varied by geographical regions [12,14,15]. To explore its additional effect on HCC, both residential and occupational factors were exposures of interest in our study.…”

“…The interaction between various risk factors of HCC was examined only among HCV, HBV and schistosomiasis in Egypt [26], and no other similar research was documented for other environmental risk factors. In southern Europe, such epidemiologic interactions between various risk factors of HCC were systematically reviewed by Donato et al [55].…”

“…In Egypt, several hospital-or community-based studies have tried to identify and establish associations between viral hepatitis and HCC over a decade [14,16,26,27]. The potential mode of transmission of HCV through occupational exposures and parenteral anti-schistosomal therapy (PAT) has also been discussed [28,29].…”

Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: A systematic review and meta‐analysis

“…10 Childhood HBV immunization in Egypt today is estimated at 95-100%, thus making it likely that HBV-related HCC will steadily decline over the next few decades. 11,12 This transition is not unique to Egypt. Many eastern Mediterranean and Middle Eastern countries are experiencing a decline in HBV due to vaccination campaigns.…”