Day 3 :
- Symposium
Location: Prestwick
Session Introduction
Dr. Ehab Abd-El-Atty
Menoufia University, Egypt
Title: HCC risk factors synergism in Egypt and how to prevent?
Time : 09:00-10:00
Biography:
Ehab Abd-El-Atty has completed his PhD at the age of 35 years from Faculty of Medicine, Menoufia University, Egypt and Master degree of Medical Sciences from Faculty of Medicine, Catholic University, Leuven, Belgium. He is Professor of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Menoufia University, Egypt. He has published more than 30 papers in reputed journals and has been serving as a reviewer of Menoufia Medical Journal (MMJ). He is a member of AASLD (American Association for the Study of the Liver Diseases), ESGE (European Society of Gastrointestinal Endoscopy) and EASL (European Association for the Study of the Liver).
Abstract:
Introduction: The burden of HCC has been increasing in Egypt with a doubling in the incidence in the past 10 years. There is a geographic correlation between the incidence of HCC and the prevalence of chronic hepatitis B and C, suggesting that these two viral infections are the most important risk factors of HCC. Several other risk factors for the development of HCC have been reported such as aging, gender, alcohol intake and NASH. Co-infection with HBV and HCV is associated with a higher risk for developing HCC than either infection alone. Materials & Method: A retrospective study of the risk factors of HCC was done in 300 Egyptian patients with HCC and 50 patients with chronic liver diseases without HCC as controls. Results: The prevalence of HBsAg and HCVAb was significantly higher in HCC cases (18% & 70%) than controls (4% & 40%) (P=0.02 & 0.0001). On multivariate analysis, the risk of HCC development in smokers with HBV or HCV was 4.90 and 8.47 respectively (P=0.0001). It was higher than in non-smokers with HBV or HCV (OR=2.48 & 4.44) (P=0.037 & 0.0001). The risk of HCC development in HBV or HCV positive patients with DM was 3.98 and 9.19 respectively (P=0.001 & 0.0001). It was higher than for HBV or HCV positive patients without DM (OR=2.80 & 4.65) (P=0.031 & 0.0001). Conclusion: HCV and HBV infections, diabetes and smoking are the main determinants of HCC development in Egypt. Proper prophylaxis, active surveillance and secondary prevention programs for patients with chronic hepatitis are the most important steps to reduce the risk of HCC. Public awareness and health education of controllable risk factors such as smoking and DM will also reduce cases of HCC.
- Advancement in New Drug Discovery for Treatment of Hepatitis
Advance Technologies for the Treatment of Hepatitis and Liver Diseases
Current Research in Hepatology
Location: Prestwick
Chair
Dr. Sen-Yung Hsieh
Chang Gung Memorial Hospital, Taiwan
Co-Chair
Dr. Faustino Bisaccia
University of Basilicata, Italy
Session Introduction
Dr. Hosny Salama
Cairo University, Egypt
Title: Effect of sofosbuvir, brand drug (sofaldi) versus generic (MPIviropack) in treating chronic HCV infection among Egyptian patients
Time : 11:45-12:10
Biography:
Hosny Salama is currently working as a Professor of Hepatology and Tropical Medicine at Cairo University, Egypt. He is the President of Egyptian Society for study of Updates in Hepatology and Gastroenterolgoy and Egyptian Society of Stem Cell Therapy. He also published many papers in national and international peer-reviewed journals.
Abstract:
Sofosbuvir is a NS5B polymerase inhibitor with effective pan-genotypic coverage and approved for use in genotype IV. With the availability of both the brand drug (Sofaldi- Gilead) and the generic form (MPI-Viropack- Marcyrl Pharmaceutical Industries) in the Egypt, we conducted this comparative study to evaluate and compare the safety and efficacy of both forms. In this study we recruited 105 patients with chronic HCV infection. For all of them the following was done: Liver function tests (S. bilirubin, ALT, AST, Albumin, PT and PC), CBS, ECG, Fundus examination, Abdominal ultrasound, Fibroscan and HCV RNA Quantitative by PCR. They were divided into three groups, 35 patients each. According to Fibroscan, in the first group, 23 patients had F2, 9 patients F3 and 3 patients F4 and the second group showed F2 in 22 patients, F3 in 10 patients and F4 in 3 patients , and the third group showed 22 patients with F2, 6 patients with F3 and 7 patients with F4. For the first group, triple therapy was used, Peg Interferon (Peg Intron- MSD according to body weight), Ribavirin in a weight adjusted dosage and Sofaldi- Gilead 400 mg once daily. For the second group, triple therapy was also used, Peg Interferon and Ribavirin as in group I and MPIviropack 400 mg once daily. For the third group, dual therapy was given using Ribavirin in a weight adjusted dosage and either Sofaldi 400 mg once daily (17 patients) or MPIviropack once daily (18 patients). Follow – up after one and three months using liver function tests, CBC and HCV RNA by PCR was done. There was normalization of liver enzymes in 34 (97%) patients group I and II, and 35 patients (100%) in the third group. CBC showed mild decrease in HB level in 18, 19, 15 patients in group I, II, III respectively. HCV RNA was not detected in 34 (97%) patients in group I, II and III. The side effects were comparable in group I and II: Nausea and abdominal Pain in 20 (57%) patients in Gr. I versus 21 (60%) in Gr. II, diarrhea in 3 (8.5%) patients in Gr. I versus 4 (11.4%) patients in Gr. II, headache in 4 (11.4%) patients in both groups. However in Group III the side effects were mild including asthenia in 20 (57%) patients and mild gastric upset in 15 (43%) patients. Follow-up is still going on to assess the SVR 12, 24 in group I and II and till the end of treatment for 6 months in group III and till we get their SVR 12, 24. From this pilot study, we found that both the brand and the generic forms of Sofosbuvir in combination with Peg/R or with Ribavirin alone proved safe and effective in Egyptian patients with chronic HCV – genotype 4 with comparable safety and efficacy profile. The long term follow-up to assess the SVR in 12, 24 weeks are still going on.
Dr. Doa a A Saleh
Cairo University, Egypt
Title: Prevalence and risk factors of HBV infection among pregnant women in urban and rural Egyptian communities
Time : 12:10-12:35
Biography:
Doa'a Saleh, is currently working as an Associate Professor of Public Health, Preventive and Social Medicine, Faculty of Medicine, Cairo University, Egypt.
Abstract:
Background: Approximately 240 million people worldwide are chronically infected with hepatitis B virus (HBV), with Egypt being an area of intermediate endemicity. Children born to hepatitis B surface antigen (HBsAg) and envelope antigen (HBeAg) positive mothers have a 70-90% chance of HBV perinatal acquisition; 85-90% of these infections become chronic. HBV vaccination in conjunction with gamma globulin at birth reduces perinatal transmission rates by 90%. Chronic HBV carriers have an increased lifetime risk of dying from hepatocellular carcinoma and liver cirrhosis and are the main reservoir for HBV transmission. Routine HBV antenatal screening is not practiced in Egypt. Aim: To assess the prevalence and risk factors for HBsAg positivity among pregnant women in one urban and three rural Egyptian communities. Design/Methods: Pregnant women seeking antenatal care in the rural health units of three villages in the Nile Delta and in the Outpatient Clinic of the Obstetrics Department, Kasr Al-Ainy School of Medicine, Cairo University, were enrolled in this perinatal cohort studying hepatitis transmission. After obtaining informed consent, serum samples were tested for HBsAg and liver function tests (ALT, AST, total and direct bilirubin). Demographic characteristics and risk factors for infection were assessed using questionnaires. All infants born to HBsAg positive women in the study were given HBV prophylaxis after delivery. Results: About 1.2% of the screened rural and urban pregnant women (42/3408 and 23/2000 respectively) were HBsAg positive. The median age of recruited women was 24 (range: 16-48) and 27 (range 19-37) years respectively. In both urban and rural communities it was found that age, parity, working in a health care facility, and history of jaundice, liver disease or viral hepatitis were not significantly associated with HBsAg. In the rural community, women with primary/preparatory school had 2.3 times greater risk to be HBsAg positive than those with a higher level of education (p=0.012). When asked about their health perceptions, HBsAg positive women were 2.5 times more likely to perceive their health as very bad (p=0.003). Family history of hepatitis, hospital admission and parenteral risk factors (surgery, blood transfusion, needle stick injury, sutures, injections, IV lines, endoscopy, renal dialysis, dental procedures, injection treatment for schistosomiasis, abortion, stillbirth, cesarean section or episiotomy) were not significantly associated with HBsAg. While in the urban community, risk factors significantly associated with HBsAg seropositivity were history of seeking medical advice in a clinic (OR=7.02), history of hospitalization (Odds ratio [OR]=6.82), history of injections (OR=5.65), history of surgery (OR = 4) and family history of hepatitis (OR=3.89) (P<0.05). There were no significant differences in levels of ALT, AST, total and direct bilirubin between those with and without HBsAg. Having hepatitis C antibodies or RNA was not associated with HBsAg seropositivity. Conclusions: Antenatal screening for HBV should be done to detect HBV-infected pregnant women to allow the application of the appropriate preventive measures for the newborn thus reducing potential perinatal transmission and liver-related complications.
Dr. Ghazala Rubi Javaid
Aga Khan University Hospital, Pakistan
Title: Genetic susceptibility of HCV RNA and its genotypic distribution in Punjab, Pakistan
Time : 12:35-13:00
Biography:
UK trained Clinical Molecular Biologist with M.Phil degree in Human Genetics & Molecular Biology and PhD Thesis in Human Genetics and Molecular Biology with more than 18 years of experience in molecular biology Pathology Laboratory services. Five years of experience of teaching to M.Phil graduates of a medical students. Working in Molecular Pathology in an international organization. Representing on national as well as international Forum. Doing different projects of Hepatitis C in different groups, ageing of HCV, diabetes & HCV in different groups of Pakistan. Keen to know the latest update on diagnosis and therapeutics to lead the services of making people free from Hepatitis. Working on HCV diagnosis and therapeutic Being a woman of third world country hard working and devoted as working on different main desks.
Abstract:
Objective: To determine the genetic pattern of HCV RNA gene and its Genotypic distribution in Punjab, Pakistan. Introduction and Rational: Susceptibility of HCV RNA gene is critical according to the host of patients of HCV as it depends on genetic variation to predict the kind of interferon treatment, response to treatment and spontaneous clearance of viral load. The respective contribution of direct HCV transmission between relatives by close contacts or exposure to an unidentified common source of virus to the intra-familial clustering of viral strains remains to be determined by an in-depth community study. Methodology: This study was undertaken to find out the ecology and Genetics of Susceptibility of HCV RNA in various isonym groups of the Punjab population. The hospital samples of chronic HCV patients, consisting of 349 patients, took the treatment of standard therapy of Interferon/Ribavirin. Thus the samples were divisible into three groups of patients, i.e., Responder, who respond to the therapy, and cured; Relapser, who relapsed after successful therapy while; Non-responder, the group of patients who did not show positive response to therapy. Results: We found that is very common (84.0%) among responder group while genotype 1a is more common in relapse (66.2%) and non-responder (54.0%) groups.Thus the genotypes of HCV play important roles relating to disease progress, prognosis and treatment. Human genetic susceptibility to HCV genotypes appears to be of great importance in getting the infection as reveled by the analyses of different ethnic /isonym groups of the Punjab. Five of the Six main genotypes, namely, 1a (61.40%), 2a (0.50%), 2b (20.00%), 3a (13.70%) and an Untypeable (4.40%) were found among the 12 different castes/tribes/isonym ethnic groups. The HCV frequency in 12 isonym groups is as follows: Arian (15.26%), Gujjar (10.02%), Jutt (18.91%), Kashmiri (10.02%), Malik (10.44%), Mughal (3.21%), Pathan (17.19%), Rajput (11.46%), Sheikh (3.43%), and Sayyed (4.87%). Gene-polymorphism for the variation of genotypes in IL-10 and IL- 28B genes was studied to find the genetic susceptibility among various isonym groups. A total of six SNPs have been found, which are as follows: In IL-10, SNP at 1082 position, AA (14.5%), GA (80.30%) and GG (5.20%); SNP at 819, AA (3.2%), AC (84.7%) and CC (12.0%); and SNP at 592 position, AA (6.0%), CA (69.9%) and CC (24.1%). CA was in high frequency than CC and AA homologous gene polymorphism. In IL-28B SNP at location a, GG (4.8%), TG (40.6%), TT (54.6%); SNP at location b, CC (34.9%), CT (58.2%), TT (6.8%) and CC (40.2%), CT (43.8%), TT (16.1%) was found. Frequency of TT homologous high at one position, CT hetrozygous polymorphism was frequent at second and third position. Conclusion: The study suggests that IL-10 and IL-28B interleukin genes, which are common in Pakistani population, in two major caste of Punjab. A cohert study should be done in detail for better understanding of human susceptibility to HCV infection and its management.