HCV burden of infection in Egypt: results from a nationwide survey
ABSTRACT Egypt is the country with the largest hepatitis C virus (HCV) epidemic in the world. In 2008, a Demographic Health Survey (DHS) was carried out in Egypt, providing for the first time a unique opportunity for HCV antibody testing on a nationwide representative sample of individuals. Consenting individuals answered a questionnaire on socio-demographic characteristics and iatrogenic exposures, before providing a blood sample for HCV antibody testing by enzyme-linked immunosorbent assay. Factors independently associated with HCV infection were examined through multivariate logistic regression models. Of 12 780 eligible subjects aged 15-59 years, 11 126 (87.1%) agreed to participate and provided a blood sample. HCV antibody prevalence nationwide was 14.7% (95% CI 13.9-15.5%) in this age group. HCV antibody prevalence gradually increased with age, reaching, in the 50-59 years age group, 46.3% and 30.8% in males and females, respectively. It was higher in males compared to females (17.4% versus 12.2%, respectively, P < 0.001), and in rural compared to urban areas (18.3% versus 10.3%, respectively, P < 0.001). In multivariate analysis, age, male sex, poverty, past history of intravenous anti-schistosomiasis treatment, blood transfusion, and living outside of the Frontier Governorates were all significantly associated with an increased risk of HCV infection. In addition, in urban areas, lack of education and being circumcised for females were associated with an increased risk of HCV infection. This study confirmed on a nationwide representative sample the very high HCV antibody prevalence in Egypt. It stresses the urgent need for strengthening prevention efforts, and bringing down the costs of antiviral drugs for countries like Egypt, where the people in the most precarious situations are also those most likely to be infected by the virus.
SourceAvailable from: Maria R. Capobianchi[Show abstract] [Hide abstract]
ABSTRACT: Daclatasvir (DCV) is an approved NS5A inhibitor with potent anti-HCV activity and broad genotype coverage. DCV resistance-associated variants (RAVs) have been described for patients infected with genotype (GT) 1, but increased GT4 prevalence in European countries as a result of immigration has boosted interest in this genotype. Establishment of NS5A variability in treatment-naive patients with HCV genotype 4 infection and a case study of the dynamics of resistance-associated variants in a virologic failure receiving pIFN/RBV+DCV, as assessed by ultra-deep sequencing. Five treatment-naïve GT4 patients (GT4a [n=1], GT4d [n=3], GT4o [n=1]) were evaluated for inclusion in the COMMAND-4 study and treatment with pIFN/RBV±DCV. Patient (Pt) 1 received pIFN/RBV; Pts2-4 received pIFN/RBV + DCV; Pt5 was a screening failure. Pt1 relapsed; Pt2 experienced breakthrough at Wk4; Pts3 and 4 achieved a sustained virologic response. No substitutions associated with DCV-resistance were detected at baseline. In terms of viremic time points for Pts1 and 2, the extent of NS5A diversity pre-treatment was not significantly related to viral load (r = -0568; p = 0.035). In Pt2, multiple substitutions associated with DCV-resistance were observed after breakthrough at NS5A amino acid positions 28, 31 and 93. These substitutions were frequently observed on the same haplotype (L28S + M31I = 55.52, 82.50, and 99.36% at Wk4, 8 and 9; L28S + M31I + Y93H = 11.77, 5.01 and <0.6% at Wk4, 8 and 9). This is the first report to describe DCV-resistance in patients infected with GT4d, supporting a possible role for a recently described RAV (L28S), and presenting the dynamics of HCV quasispecies during therapy failure, with indications of changes of diversity and association of mutations. Copyright © 2015 Elsevier B.V. All rights reserved.Journal of Clinical Virology 02/2015; 66. DOI:10.1016/j.jcv.2015.02.001 · 3.47 Impact Factor
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ABSTRACT: Introduction La prévalence du virus de l’hépatite C (VHC) n’est pas bien connue au Burundi. Des études parcellaires rapportent des taux variés. Aucune étude couvrant le territoire national n’avait été faite. But Déterminer la prévalence des anticorps anti virus de l’hépatite C (AcVHC) au Burundi. Méthodes Lors d’une enquête nationale de séroprévalence du VIH menée par le CEFORMI du CHU Kamenge en 2002, entre 2 et 4 ml de sérum et de plasma ont été décantés pour chaque échantillon puis conservés à -20°C pour usage ultérieur. Nous avons repris et analysé ces échantillons. Résultats Au total, 5569 individus ont été enrôlées, 2660 (47,8%) hommes et 2909 (52,2%) femmes. L’âge moyen était de 31±15 ans avec une médiane de 28 ans. Au niveau national, la prévalence globale des AcVHC était de 8,2%. Elle était de 8,3% chez l’homme et de 8,1% chez la femme. Selon les strates, la prévalence était de 10% en zone urbaine, de 9,1% en zone semi-urbaine et de 7,4% en zone rural. La co-infection avec le VIH était de 1,3% en zone urbaine, de 0,8% en zone semi-urbaine et de 0,1% en zone rurale. Conclusion La prévalence du virus de l’hépatite C est estimée à 8,2%. Elle est parmi les plus élevées en Afrique.Journal Africain d?Hépato-Gastroentérologie 03/2014; 8(1):25-28. DOI:10.1007/s12157-014-0511-6
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ABSTRACT: Single-nucleotide polymorphisms (SNPs) around the interferon lambda 3 (IFNL3; also known as interleukin 28B; IL28B) gene are associated with spontaneous hepatitis C virus (HCV) clearance. Interferon lambda 4 (IFNL4).ss469415590, in linkage disequilibrium (LD) with IFNL3.rs12979860 among the Caucasian population, has recently been identified as a potential functional variant. Our objective was to assess the LD between IFNL3.rs12979860 and IFNL4.ss469415590 and to compare their effect on the outcome of HCV infection among Egyptians, mainly infected with HCV genotype 4. One-hundred and eighty-five Egyptian HCV patients (77 spontaneous resolvers and 108 chronic subjects), and 122 healthy controls were genotyped for both IL28B.rs12979860 and IFNL4.ss469415590. Logistic regression models including factors with univariate association with the outcome of infection were calculated for each genetic marker. The LD was also calculated for the 122 healthy controls. The CC genotype of IFNL3.rs12979860 was more frequent among individuals with HCV spontaneous resolution than among those with chronic infection (57 vs. 27 %; adjusted OR 3.84; 95 % CI 2.02-7.30; p < 0.0001). Also, the TT/TT genotype of IFNL4.ss469415590 was more frequent among individuals with spontaneous resolution (49 vs. 20 %; adjusted OR 4.17; 95 % CI 2.12-8.19; p < 0.0001). Both markers were in LD (D' = 0.96; r (2) = 0.84). The IFNL3.rs12979860 and IFNL4.ss469415590 variants have comparable effects on spontaneous resolution of HCV among Egyptians, for whom both markers are closely linked.Hepatology International 03/2015; DOI:10.1007/s12072-015-9619-z · 2.47 Impact Factor