Emily Schiefelbein

Characterization of the Viral Profile of Hepatocellular Carcinoma with Respect to HBV and HCV Infection in Gharbiah Governorate, Egypt

ABSTRACT: Worldwide, hepatocellular carcinoma (HCC) is the most common form of liver cancer. It is the fifth most frequently occurring tumor (average of both men and women) in the classification of all malignancies and the third leading cause of cancer deaths. Primary human liver cancer accounts for more than 500,000 cancer deaths each year. There has been a marked increase in incidence of HCC in Egypt, from approximately 4.0% in 1993 to 7.3% in 2003, becoming the second highest cause of cancer incidence and mortality in men. Diagnosis often occurs late and prognosis for HCC remains poor. Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are two of the primary risk factors for HCC, along with exposure to dietary aflatoxins. With an estimated 80% of HCC etiologically associated worldwide, chronic infection with HBV has proved to be the most important risk factor. An estimated 66% of Egyptians in the general population between 40-70 years old are believed to be HBV infected. Due to successful implementation of a vaccination program in Egypt, the influence of HBV on HCC has been decreasing. The recent increase in cases of HCC in Egypt is generally attributed to HCV. Egypt has the highest prevalence of HCV in the world, with an estimate of 15-20% of the population. The proposed study is part of a large case-control study assessing the etiologic factors and molecular characterization of liver cancer. The objective of this portion of the case-control study is to determine the viral profile of HCC with respect to HBV and HCV. This study will estimate the individual and combined risk of HCC associated with HBV and HCV. One group of 200 cases and two groups of 200 controls each (hospital and visitors controls) will be recruited. Blood samples and questionnaire data will be collected from each participant and serological tests will be used to determine HBV and HCV status. The full HBV profile will be assessed by manual chromatographic assay (ELISA) and HCV will be assessed by branched-DNA assay. HBV DNA and HCV RNA will be extracted and PCR and RT-PCR and line probe assay will be utilized to quantify and confirm HBV and HCV infection. An understanding of the etiology and pathogenesis of liver cancer has direct implications for both prevention and treatment in Egypt and the U.S. The results of this research will help in allocating resources for prevention and management of liver cancers based on specific viral etiology.

Epidemiologic risk factors of hepatocellular carcinoma in a rural region of Egypt