Amira Mohsen

Analysis of IL28B Variants in an Egyptian Population Defines the 20 Kilobases Minimal Region Involved in Spontaneous Clearance of Hepatitis C Virus

Spontaneous clearance of hepatitis C virus (HCV) occurs in ∼30% of acute infections. Host genetics play a major role in HCV clearance, with a strong effect of single nucleotide polymorphisms (SNPs) of the IL28B gene already found in different populations, mostly infected with viral genotypes 1 and 3. Egypt has the highest prevalence of HCV infection in the world, which is mostly due to viral genotype 4. We investigated the role of several IL28B SNPs in HCV spontaneous clearance in an Egyptian population. We selected nine SNPs within the IL28B genomic region covering the linkage disequilibrium (LD) block known to be associated with HCV clearance in European populations. These SNPs were genotyped in 261 HCV-infected Egyptian subjects (130 with spontaneous clearance and 131 with chronic infection). The most associated SNPs were rs12979860 (P = 1.6×10−7) and the non-synonymous IL28B SNP, rs8103142 (P = 1.6×10−7). Interestingly, three SNPs at the two bounds of the region were monomorphic, reducing the size of the LD block in which the causal variants are potentially located to ∼20 kilobases. HCV clearance in Egypt was associated with a region of IL28B smaller than that identified in European populations, and involved the non-synonymous IL28B SNP, rs8103142.

Hepatitis C virus acquisition among Egyptians: analysis of a 10-year surveillance of acute hepatitis C

To identify current risk factors for hepatitis C virus (HCV) acquisition among Egyptians.

Apolipoprotein H expression is associated with IL28B genotype and viral clearance in hepatitis C virus infection

BACKGROUND & AIMS HCV requires host lipid metabolism for replication, and apolipoproteins have been implicated in the response to treatment. METHODS We examined plasma apolipoprotein concentrations in three cohorts of patients: mono-infected patients with symptomatic acute hepatitis C (aHCV); those undergoing treatment for chronic hepatitis C (cHCV); and HIV/HCV co-infected patients being treated for their chronic hepatitis C. We also evaluated associations between apolipoproteins and IL28B polymorphisms, a defined genetic determinant of viral clearance. RESULTS Plasma apolipoprotein H (ApoH) levels were significantly higher in patients who achieved spontaneous clearance or responded to pegylated-interferon/ribavirin therapy. Strikingly, patients carrying the IL28B rs12979860 CC SNP correlated with the plasma concentration of ApoH in all three cohorts. Both ApoH and IL28B CC SNP were associated with HCV clearance in univariate analysis. Additional multivariate analysis revealed that the association between IL28B and HCV clearance was closely linked to that of Apo H and HCV clearance, suggesting that both belong to the same biological pathway to clearance. The association between IL28B CC SNP and ApoH was not observed in healthy individuals, suggesting that early post-infection events trigger differential ApoH expression in an IL28B allele dependent manner. CONCLUSIONS This relationship identifies ApoH as the first induced protein quantitative trait associated with IL28B, and characterises a novel host factor implicated in HCV clearance.

Early and long term anamnestic response to HBV booster dose among fully vaccinated Egyptian children during infancy

OBJECTIVE To evaluate early and long term anamnestic response to a booster dose of HBV vaccine among non-seroprotected children. SUBJECTS AND METHOD A national community based project was carried out on 3600 children aged 9 months to 16 years, fully vaccinated during infancy. They were recruited from 6 governorates representing Egypt. It revealed that 1535 children (42.8%) had non sero-protective anti-HBs (<10 IU/L) and were HBsAg or anti-HBc negative. A challenging dose of 10 μg of mono-valent Euvax HBV vaccine was given to 1121/1535 children. Quantitative assessment of anti-HBs was performed to detect early (2-4 weeks) and long term (one year) anamnestic responses. RESULTS Early anamnestic response developed among 967/1070 children (90.3%).Children having detectable anti-HBs (1-9 IU/L) significantly developed early anamnestic response (90%) compared to 85% with undetectable anti-HBs (<1 IU/L), P < 0.001. Multiple logistic analysis revealed that undetectable anti-HBs, living in rural residence and children aged 15-16 years were the most significant predicting risk factors for the absence of early anamnestic response (<10 IU/L), with AOR 2.7, 2.7 & 4.7 respectively. After one year, long term anamnestic response was absent among 15% of children who previously showed early response. Poor early anamnestic response and undetectable pre-booster anti-HBs were the significant predicting risk factors for absent long term anamnestic response, with AOR 18.7 & 2.7 respectively. CONCLUSION Immunological memory for HBV vaccine outlasts the presence of anti- HBs and HBV vaccination program provides effective long term protection even in children showing waning or undetectable concentrations of anti-HBs. This signifies no need for a booster dose especially to healthy children.

Association between hepatitis C infection and cerebro-cardiovascular disease: analysis of a national population-based survey in Egypt

To examine the association between hepatitis C virus (HCV) infection, cardiovascular risk factors and cerebro‐cardiovascular (CCV) disease.

Hypertension and associated cardiovascular risk factors among urban slum dwellers in Egypt: a population-based survey

Background The economic deprivation of most slum inhabitants, and the lack of services and facilities may increase their vulnerability to unhealthy lifestyles and cardiovascular diseases. Aims This study aimed to determine the prevalence of modifiable risk factors for cardiovascular diseases in slum residents in Cairo, Egypt and evaluate their association with hypertension. Methods A household cluster survey was conducted in Mansheiet Nasser, a large slum area in Cairo. The study included 984 adult participants. The World Health Organization STEPS instrument for noncommunicable disease risk factor surveillance was used to determine the prevalence of smoking, fruit/vegetable consumption, overweight/obesity, physical activity, diabetes and hypertension. Results Smoking, insufficient fruit/vegetable consumption, low physical activity and diabetes were reported by 43.4%, 92.2%, 98.4% and 8.7% of the sample respectively. The prevalence of hypertension and overweight/obesity were 31.2% and 73.0% respectively. Most of the participants (83.8%) had ≥ 3 cardiovascular risk factors. A significantly higher proportion of men smoked, engaged in less physical activity, had diabetes and had multiple risk factors. Hypertension was significantly associated with age 30-< 50 years (OR = 3.04, 95% CI: 1.66-5.58), age ≥ 50 years (OR = 12.5, 95% CI: 6.71-23.26), overweight (OR = 1.58, 95% CI: 1.0-62.35), obesity (OR = 2.23, 95% CI: 1.49-3.35), low fruit/vegetable consumption (OR = 1.88, 95% CI: 1.02-3.48), and diabetes (OR = 1.77, 95% CI: 1.08-2.92). Conclusions Urban slum dwellers in Mansheiet Nasser have an increased vulnerability to cardiovascular diseases compared with the Egyptian population. Measures are needed to improve their lifestyles and reduce their risk of cardiovascular diseases.

Association of rotating night shift with lipid profile among nurses in an Egyptian tertiary university hospital.

The main objective was to identify whether night shift nurses are more prone to dyslipidaemia than day shift nurses. One hundred and fifty female nurses aged 20-49 years were recruited from Ain Shams University Hospitals, Egypt, from January to March 2016: 64 day shift and 86 night shift. Diet type was assessed by interview questionnaire and job satisfaction was assessed using the job satisfaction survey. Triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were measured in all nurses. The predictors of high TG level were ages 30-39 and ≥ 40 years and night shift. The only predictor of high LDL level (> 130 mg/dl) was age ≥ 40 years. An unhealthy diet and night shift were predictors of risky HDL levels. Seventy nurses were unsatisfied with their jobs, and 137 ate a semi-healthy diet. The findings emphasize that night shift nurses are at risk of abnormal lipid profile, therefore an occupational programme to help nurses cope with their employment conditions is necessary.

Women's awareness of obstetric danger symptoms: is there a need to promote a preconceptional educational program?

Background/aim Awareness towards the symptoms of obstetric complications will lead to timely access to appropriate emergency obstetric care. The aim of the study was to assess and compare the awareness towards obstetric danger symptoms among never-pregnant and ever-pregnant women and to identify predictors of their awareness as a measure for the need to promote a preconceptional educational program in Egypt. Participants and methods This study was conducted in selected villages of Alfayoum and Benisuef governorates as a comparative study between 173 newly married never-pregnant women and 827 ever-pregnant women who were randomly targeted by a structured interview during a period of 8 months. The questionnaire included personal data, social data, and data related to awareness of obstetric danger symptoms, complications, and action taken on having any of these symptoms. The scoring system was designed for women′s awareness, with one degree allocated for a correct answer. Results The study revealed that the percent of women who gained a score of knowledge of at least 50% was higher among ever-pregnant women than among never-pregnant women (43.9 and 19.1%, respectively). Although bleeding is the highest reported cause for obstetric complications and is one of the reported causes of maternal deaths in the studied villages, only 26.6 and 20.2% of the never pregnant and 43.9 and 34.3% of the ever pregnant groups, respectively, knew that bleeding is a danger symptom during delivery and the postnatal period. Meanwhile, better awareness about obstetric danger symptoms and exposure to health educational messages was significantly higher among ever-pregnant women (OR = 3.08 and 2.28, respectively) (P < 0.001). Conclusion This study reflects the need for intensifying antenatal health educational messages given to pregnant women and the need for the implementation of preconceptional health education programs.

455 APOLIPOPROTEIN H IS STRONGLY ASSOCIATED WITH IL28B SNP GENOTYPE AND PREDICTS VIRAL CLEARANCE IN BOTH ACUTE AND CHRONIC HEPATITIS C VIRUS INFECTION

455 APOLIPOPROTEIN H IS STRONGLY ASSOCIATED WITH IL28B SNP GENOTYPE AND PREDICTS VIRAL CLEARANCE IN BOTH ACUTE AND CHRONIC HEPATITIS C VIRUS INFECTION M.E. Laird, A. Mohsen, R. Saleh, D. Duffy, L. Le Fouler, M. El-Daly, M. Rafik, M. Abdel-Hamid, M.K. Mohamed, P. Bonnard, V. Mallet, S. Pol, M. Albert, A. Fontanet, The ANRS HC 20 ETOC Study Group. Immunology, Institut Pasteur, Paris, France; Community Medicine Department, National Research Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Emerging Disease Epidemiology, Institut Pasteur, Paris, France; Liver Disease Research, National Hepatology and Tropical Medicine Research Institute, Cairo, Faculty of Medicine, Minia University, Minia, Egypt; Maladies Infectieuses et Tropicales, Hopital Tenon (APHP), INSERM U 707, UPMC, Universite Paris Descartes, Institut Cochin, INSERM (IMR-S 1016), CNRS (UMR 8104), Unite d’Hepatologie, Assistance Publique, Hopitaux de Paris (APHP), Groupe Hospitalier Cochin Saint-Vincent de Paul, INSERM U 818, Conservatoire National des Arts et Metiers, Paris, France E-mail: fontanet@pasteur.fr