Omar Hanan Hassan
Clinical Pathology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Hepat Med. 2019 Sep 3;11:131-136. doi: 10.2147/HMER.S155962. eCollection 2019.
Schistosomiasis is a public health problem in many countries. Its prevalence is increasing annually; the current infection rate is one in 30 individuals. The WHO reported that at least 206.4 million people all over the world required preventive treatments for schistosomiasis in 2016. Chronic schistosomiasis, hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection are common in countries where schistosomiasis is endemic. The effects of the hepatotropic virus co-infection may modify the Th2-dominated granulomatous phase of schistosomal infection. These viruses induce a strong-specific T cell response, with infiltration of large numbers of specific interferon-γ-producing CD8+ cells into the liver. The outcome of liver diseases depends on the underlying causes, host immune response and concomitant infections. Co-infection of schistosomiasis with HBV/HCV infection causes advanced liver disease and worsens the outcome, especially with higher viral load titers, which increase the mortality rate through an increased incidence of liver cirrhosis and hepatocellular carcinoma. The exposure risk for HBV in patients with HCV and schistosomiasis was two and half times greater than that in CHC patients without schistosomiasis. Finally, chronic schistosomiasis and HBV/HCV co-infection have serious effects on liver pathology. Co-infection accelerates the progression of liver disease and leads to advanced liver diseases and liver failure.
血吸虫病在许多国家都是一个公共卫生问题。其患病率逐年上升；目前的感染率为每30人中就有1人。世界卫生组织报告称，2016年全球至少有2.064亿人需要接受血吸虫病预防性治疗。在血吸虫病流行的国家，慢性血吸虫病、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）合并感染很常见。嗜肝病毒合并感染的影响可能会改变血吸虫感染以Th2为主导的肉芽肿期。这些病毒诱导强烈的特异性T细胞反应，大量产生特异性干扰素-γ的CD8+细胞浸润到肝脏中。肝脏疾病的结局取决于潜在病因、宿主免疫反应和合并感染。血吸虫病与HBV/HCV感染合并会导致晚期肝病并使结局恶化，尤其是病毒载量较高时，会通过增加肝硬化和肝细胞癌的发病率来提高死亡率。丙型肝炎和血吸虫病患者感染HBV的风险比无血吸虫病的丙型肝炎患者高2.5倍。最后，慢性血吸虫病与HBV/HCV合并感染对肝脏病理有严重影响。合并感染会加速肝病进展并导致晚期肝病和肝衰竭。
