Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of latrogenic and biological factors
Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of latrogenic and biological factors
复制标题
DOI：
10.1002/hep.21173
复制
发表时间：
2006-05-01
期刊：
影响因子：
13.5
通讯作者：
Strickland, GT
中科院分区：
文献类型：
--
作者：
Strickland, GT
在埃及，血吸虫病传统上是最重要的公共卫生问题，曼氏血吸虫感染是肝病的主要原因。从20世纪50年代到80年代，埃及卫生部（MOH）开展了大规模的控制运动，使用静脉注射吐酒石，作为血吸虫病的标准治疗，作为社区范围的治疗。这一值得称赞的控制重大健康问题的努力不幸在该国建立了一个非常大的丙型肝炎病毒库。到20世纪80年代中期，有效的口服药物吡喹酮取代了吐酒石，成为全国血吸虫病的治疗药物。这既减少了染色体传播和疾病，又中断了“隐匿性”HCV流行。很明显，当诊断血清学在20世纪90年代出现时，HCV已经取代血吸虫病成为慢性肝病的主要原因。流行病学研究报告了HCV的高流行率和发病率，特别是在血吸虫病流行的农村地区的家庭中。临床研究表明，70%至90%的慢性肝炎、肝硬化或肝细胞癌患者有HCV感染。合并感染血吸虫病比单独感染HCV引起更严重的肝脏疾病。据报道，血吸虫病导致HCV特异性T细胞反应失衡，导致病毒载量增加，HCV慢性化的可能性更高，合并感染者并发症的进展更快。由于丙型肝炎病毒的并发症通常在感染20年后发生，埃及疫情的高峰影响尚未出现。埃及卫生部已开始努力预防估计有600万感染者出现新的丙型肝炎病毒感染和并发症。
In Egypt, schistosomiasis was traditionally the most important public health problem and infection with Schistosoma mansoni the major cause of liver disease. From the 1950s until the 1980s, the Egyptian Ministry of Health (MOH) undertook large control campaigns using intravenous tartar emetic, the standard treatment for schistosomiasis, as community-wide therapy. This commendable effort to control a major health problem unfortunately established a very large reservoir of hepatitis C virus (HCV) in the country. By the mid-1980s, the effective oral drug, praziquantel, replaced tartar emetic as treatment for schistosomiasis in the entire country. This both reduced schistosomal transmission and disease and interrupted the "occult" HCV epidemic. It was evident when diagnostic serology became available in the 1990s that HCV had replaced schistosomiasis as the predominant cause of chronic liver disease. Epidemiological studies reported a high prevalence and incidence of HCV, particularly within families in rural areas endemic for schistosomiasis. Clinical studies showed 70% to 90% of patients with chronic hepatitis, cirrhosis, or hepatocellular carcinoma had HCV infections. Co-infections with schistosomiasis caused more severe liver disease than infection with HCV alone. Schistosomiasis was reported to cause an imbalance in HCV-specific T-cell responses leading to increased viral load, a higher probability of HCV chronicity, and more rapid progression of complications in co-infected persons. As complications of HCV usually occur after 20 years of infection, the peak impact of the Egyptian outbreak has not yet occurred. Efforts have been initiated by the Egyptian MOH to prevent new infections and complications of HCV in the estimated 6 million infected persons.