CHRONIC LIVER-DISEASE IN THE ALEXANDRIA GOVERNORATE, EGYPT - CONTRIBUTION OF SCHISTOSOMIASIS AND HEPATITIS-VIRUS INFECTIONS

Background/Aims: In Egypt chronic liver disease is customarily attribu ted to Schistosoma mansoni infection, Anti-HCV antibodies are highly p revalent among Egyptian blood donors, yet little is known about the ri sk factors, pathogenicity and virological features of HCV and its asso ciation with schistosomiasis, We studied 135 adult patients with chron ic liver disease living in the Alexandria governorate, mostly in rural areas of the Nile Delta. Methods: Evaluation included abdominal ultra sonography; detection of anti-HCV antibodies and markers of HBV and HD V infection; HCV-RNA assay by 5' untranslated region nested polymerase -chain-reaction and HCV genotyping by a line probe assay; serologic (a nti-soluble egg antigen, anti-SEA) and parasitological examinations fo r Schistosoma mansoni infection; and liver biopsy if not contraindicat ed. Results: Ninety-one (67%) patients had anti-HCV and 107 (85%) anti -SEA, 32 (30%) of whom excreted schistosomal eggs in stools, In additi on, 21 (16%) patients had HBsAg, 86 (64%) anti-HBc and four (3%) anti- delta, Thus, many patients had evidence of multiple infections, double in 66% (anti-HCV and anti-SEA), triple in 33% (anti-HCV HBsAg and ant i-SEA), Based on our diagnostic criteria, 25 (19%) patients had schist osomal portal fibrosis (anti-HCV positive in eight), 24 (18%) chronic hepatitis (anti-HCV positive in 19), 76 (56%) cirrhosis (anti-HCV posi tive in 58) and 10 hepatic tumors (anti-HCV positive in six), At multi variate analysis, the presence of anti-HCV was independently associate d with previous parenteral anti-schistosomal therapy, a history of hem atemesis and seropositivity for anti-HBc. Fifty (55%) of 91 anti-HCV p ositive sera had HCV-RNA, in 41 cases classified as genotype 4a. Detec tion of HCV-RNA was associated with a more severe liver disease and oc curred less frequently in patients with a history of schistosomiasis. Conclusions: HCV infection with genotype 4a is the main cause of sever e chronic liver disease in Egypt, where it is highly associated with s chistosomiasis.