Hepatitis C and cirrhotic liver disease in the Nile delta of Egypt: A community-based study

Residents of Egypt's Nile river delta have among the world's highest seropr evalence of hepatitis C virus (HCV) infection. To assess the impact of HCV on chronic liver disease, we studied the association between HCV, other hep atitis viruses, and cirrhotic liver disease in a cross-sectional, community -based survey of 801 persons aged greater than or equal to 10 years living in a semi-urban, Nile delta village. Residents were systematically sampled using questionnaires, physical examination, abdominal ultrasonography and s erologically for antibodies to HCV (confirmed by a third-generation immunob lot assay) and to hepatitis A virus (HAV), hepatitis B virus (HBV), and hep atitis E virus (HEV). The seroprevalence of HCV increased with age from 19% in persons 10-19 years old to about 60% in persons 30 years and older. Alt hough no practices that might facilitate HCV transmission were discovered, the seroprevalence of HCV was significantly associated with remote (> 1 yea r) histories of schistosomiasis. Sonographic evidence of cirrhosis was pres ent in 3% (95% CI: 1%, 4%) of the population (0.7% of persons under 30 year s of age and in 5% of older persons), and was significantly associated with HCV seroreactivity. Our findings are consistent with the hypothesis that p ast mass parenteral chemotherapy campaigns for schistosomiasis facilitated HCV transmission, and that HCV may be a major cause of the high prevalence of liver cirrhosis in this Nile village.