The changing pattern of viral hepatitis in Saudi Arabia

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The changing pattern of viral hepatitis in Saudi
Arabia

• Yousef Qari, MD, FRCP(C), ABIM
• Gastoenterologist
• King Abdulaziz University Hospital

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Epidemiology of Hep B Worldwide

• 2 billion people are infected with this virus
• 350 million Chronic HBV infection.
• 10th leading cause of death in the world

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Route of Transmission of HepB

• High endemicity
• Perinatal (vertical)
• Acquired in preschool years.
• Low endemicity
• Early adult life
• Intravenous drug use
• Unprotected sexual activities

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The prevalence of HBsAg and other markers of HBV
among residents of Jizan
Ayoola AE Saudi Med J.  2003 24(9)991-5
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Prevalence of HBV, HCV among blood donors in a
teaching hospital in the Central region of Saudi
Arabia.
24000 patients
El-Hazmi MMSaudi Med J.  2004 25(1)26-33 
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HBV and HCV prevalence among dialysis patients
in Bahrain and Saudi Arabia
Qadi AA Am J Infect Control.  2004
32(8)493-5 (ISSN 0196-6553)
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Prevalence of hepatitis C virus among
Bilharziasis patients in Eastern Saudi arbia
Khan ZA Saudi Med J.  2004 25(2)204-6 
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Worled Prevalence of Hep B
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The decline of hepatitis B viral infection in
South-Western Saudi Arabia.
Ayoola AE Saudi Med J.  2003 24(9)991-5 
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Hepatitis C virus Seroprevalence rate among
Saudis
Shobokshi OA . Saudi Med J.  2003 24 Suppl
2S81-6 
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Worled Prevalence of Hep C
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Pattern of liver diseases at a University
Hospital in Western Saudi Arabia.
Mansoor I. Saudi Med J.  2002 23(9)1070-3
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Overview of Epidemiology of viral Hepatitis in
Saudi Arabia

• The prevalence rate is high in Saudi Arabia.
• HBV 8-10
• HCV 2-6
• Age distribution
• HAV, is mainly a disease of the young
• HBV, a disease of adolescents and adults
• HCV, a disease of the elderly.
• Male Female ratio
• Equal in HAV and HCV
• More males were affected with HBV than females.

Memish Z Mil Med.  2003 168(7)565-8 
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The natural history of HCV infection contd.

• Factors that contribute to the chronicity
• Male gender
• Age
• Alcohol intake, and
• The degree of liver fibrosis on initial biopsy.
• Extrahepatic complication (EHC).
• 38 will have at least one EHC
• The most important EHC is mixed cryoglobulinemia.
  

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Natural History of Hep C
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The natural history of HCV infection in Saudi
Arabia.
Similer pattern was noted for the rate of
progression to cirrhosis and HCC
Al-Quaiz MN Saudi Med J.  2003 24 Suppl
2S67-70 
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Natural History of Hep C
HBV Infection
15-40
HBV
Chronic Hepatitis Cirrhosis HCC
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Hepatocellular carcinoma in Saudi Arabia Role of
hepatitis B infection.
1.9 per 1000 (2.3 in men, 1.2 in women).
N118
N118
Ayoola EA J Gastroenterol Hepatol.  2004
19(6)665-9 
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The prevalence of hepatitis B core antibody
positivity in donors for liver transplantation in
Saudi Arabia.
Non-Saudi (41.3) Saudi nationals (16.7).
Al-Sebayel MI . Saudi Med J.  2002
23(3)298-300 
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The challenge of finding donors for living donor
liver transplantation in Saudi Arabia.
Khalaf H Transplant Proc.  2004 36(8)2222-3 
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Hepatitis C genotypes/subtypes among chronic
hepatitis patients in Saudi Arabia

1. Shobokshi OA Saudi Med J.  2003 24 Suppl
   2S87-91
2. Al-Traif I Saudi Med J.  2004 25(12)1935-8 

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Chronic hepatitis C. Genotypes and response to
anti-viral therapy among Saudi patients.
Al-Traif I Saudi Med J.  2004 25(12)1935-8 
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Peg IF Ribavirin compared with IF Ribavirin
for initial treatment of Ch. HCV in Saudi
patients with genotype 4.

• 96 patients with chronic HCV
• End of treatment (48 weeks)
• Sustained (72 weeks)

Alfaleh FZ Liver Int.  2004 24(6)568-74 
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Conclusion

• The most prevalent genotype in the Kingdom of
  Saudi Arabia is
• genotype 4
• genotypes 1a and 1b.
• Genotype 5 was identified exclusively in the
  Western province and nowhere else.
• Genotypes 2a,/2b, 3 and 6 are very rare in the
  Kingdom of Saudi Arabia.

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Conclusion

• 86 of Saudi chronic hepatitis C cases are due to
  genotypes 1 and 4.
• The low prevalence of HBsAg in children, provides
  evidence for the effectiveness and efficacy of
  the integration of hepatitis B vaccination into
  the extended program of immunization in KSA.
• The significant decline of HBV markers among
  unvaccinated Saudi adults indicated an indirect
  effect of other factors like health education and
  socio-economic progress

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Conclusion

• Hepatitis B virus constitutes a major risk factor
  and HCV contributes a less significant role in
  the development of HCC.
• The ongoing program of HBV vaccination may
  significantly decrease the prevalence of
  HBV-associated HCC in Saudi Arabia
• The present public health schemes have been
  effective in reducing hepatitis C infection in
  the general community in the Kingdom of Saudi
  Arabia but the infection among high risk groups
  remain a major problem that needs to be actively
  addressed.

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Conclusion

• In Saudi Arabia, donor availability as well as
  recipient characteristics may limit the value of
  LDLT in overcoming organ shortage. Therefore,
  efforts should be directed to improve the number
  and quality of available cadaveric organs. Until
  then, LDLT may be the only way forward to save
  patients from dying on the waiting list.

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Thankyou Omrah Mubarakah Inshaallah
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Hepatitis E virus infection in haemodialysis
patients a case-control study in Saudi Arabia.
83 Saudi patients on chronic haemodialysis
Ayoola EA J Med Virol.  2002 66(3)329-34
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Treatment of patients with HCV with normal liver
enzymes in a Saudi population.
Akbar HOSaudi Med J.  2002 23(3)301-4 
Both groups treated with IF 3mu thrice / w
Ribavirin
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The natural history of HCV infection.

• The natural history of HCV infection is not fully
  understood.
• Early studies of natural history reflected the
  more severe end of the spectrum of the disease.