Résumé
La prévalence de l’hépatite B et de l’hépatite C en Afrique est élevée avec d’importantes différences selon les pays, en lien avec des modes de transmission différents. Il existe aussi des différences importantes selon les pays concernant la prévalence de l’excès pondéral et l’obésité mais, globalement leur prévalence est élevée et en augmentation. Ces comorbidités peuvent en elles-mêmes être responsables d’une maladie héptique sévère; mais aussi accroître la sévérité d’une hépatite virale chronique ainsi que diminuer la réponse au traitement antiviral. Ces données épidémiologiques et physiopathologiques expliquent une fréquente association de ces comorbidités. Quand un traitement est envisagé pour une hépatite B ou C, il est important de prendre en compte ces éventuelles comorbidités.
Abstract
The prevalence of hepatitis B and C is high in Africa, with major differences between countries based on varying transmission routes. Some striking differences have been observed in overweight and obese patients, but, in general, prevalence is high and on the rise. In some countries, alcohol consumption is high. These comorbidities alone could lead to severe liver disease, potentiate the severity of viral induced liver disease and decrease the response to antiviral treatment. Epidemiologic and pathophysiological data have demonstrated a frequent association between these comorbidities. When addressing the treatment of hepatitis B and C, it is important to take into account their possible association with alcohol abuse, overweight and obesity.
Références
(2003–2004) Estimation des taux de prévalence des anticorps anti-VHC et des marqueurs du virus de l’Hépatite B chez les assurés sociaux du régime général de France métropolitaine, www.invs.sante.fr/publications/2005/
Alcool, effets sur la santé, expertise collective Inserm (2001) Éditions Inserm, pp 1–34
Angulo P (2002) Non alcoholic fatty liver disease. N Engl J Med 346:1221–1231
Feld JJ, Ocama P, Ronald A (2005) The liver in HIV in Africa. Antiviral therapy 10: 953–965
Crockett SD, Keeffe EB (2005) Natural history and treatment of hepatitis B virus and hepatitis C coinfection. Ann Clin Microbiol Antimicrob 4: 13
Mendez MA, Monteiro CA, Popkin BM (2005) Overweight exceeds underweight among women in most developing countries. Am J clin Nutr 81: 714–721
Belahsen R, Mziwira M, Fertat F (2003) Anthropometry of women of chilbearing age in Morocco:body composition and prevalence of overweight and obesity. Public Health Nutrition 7: 523–530
Pasquet P, Temgoua S, Melaman-sego F, et al. (2003) Prevalence of overweight and obesity for urban adults in Cameroon. Ann Hum Biol 30: 551–562
Fezeu L, Minkoulou E, Balkau B, et al. (2005) Association between socioeconomic status and adiposity in urban Cameroon. Internat J Epidemiol 35: 105–111
Patton HM, Patel K, Behling C, et al. (2004) The impact of steatosis on disease progression and early and sustained treatment response in chronic hepatitis C patients. J Hepatol 40: 484–490
Mihm S, Fayyazi A, Hartmann H, et al. (1997) Analysis of histopathological manifestations of chronic hepatitis C virus infection with respect to virus genotype. Hepatology 25: 735–739
Kumar D, Farell GC, Fung E, et al. (2002) Hepatitis C virus genotype 3 is cytopathic to hepatocytes: reversal of hepatitis steatosis after sustained therapeutic response. Hepatology 36: 1266–1272
Castera L, Hezode C, Roudot-Thoraval F, et al. (2003) Worsening of steatosis is an independent factor of fibrosis progression in untreated patients with chronic hepatitis C and paired liver biopsies. Gut 52: 288–292
Hourigan LF, Mac Donald GA, Purpie D, et al. (1999) Fibrosis in chronic hepatitis C correlates significantly with body mass index and steatosis. Hepatology 29: 1215–1219
Adinolfi LE, Gambardella M, Andreana A, et al. (2001) Steatosis accelerates the progression of liver damage of chronic hepatitis C and correlates with specific HCV genotype and visceral obesity. Hepatology 33: 1358–1364
Mehta SH, Brancati FL, Sulkowski MS, et al. (2000) Prevalence of type 2 diabetes mellitus among persons with hepatitis C infection in United States. Ann Intern Med 1333: 592–599
Monto A, Alonzo J, Watson JJ, et al. (2002) Steatosis in chronic hepatitis C: relative contributions of obesity, diabetes mellitus and alcohol. Hepatology 36: 729–736
Patton HM, Patel K, Mc Hutchinson JG (2004) Hepatitic steatosis in chronic hepatitis C virus infection: a review of mechanisms, influence or natural history and treatment outcomes. Hepatology Rev 1: 72–80
Romero Gomez M, Castellano-megias VM, Grande L, et al. (2003) Serum leptin correlate with hepatic steatosis in chronic hepatitis C. Am J Gastroenterol 98: 1135–1141
Shintani Y, Fujie H, Miyoshi H, et al. (2004) Hepatitis C virus infection and diabetes: direct involvement of the virus in the development of insulin resistance. Gastroenterology 126: 840–848
Poynard T, Ratziu V, Mc Hutchinson J, et al. (2003) Effect of treatment with peginterferon or interferon alpha 2b and ribavirin on steatosis in patients infected with hepatitis C. Hepatology 38: 75–85
Sanyal AJ, Contos MJ, Sterling RK, et al. (2003) Non alcoholic fatty liver disease in patients with hepatitis C is associated with features of the metabolic syndrome. Am J Gastroenterol 98: 2064–2071
Safdar K, Schiff ER (2004) Alcohol and hepatitis C. Sem Liv Dis 24: 305–313
Pessione F, Degos F, Marcellin P, et al. (1998) Effect of alcohol consumption on serum hepatitis C virus RNA and histological lesions in chronic hepatitis C. Hepatology 27: 1717–1722
Loguercio C, Di Pierro M, Di Marino MP, et al. (2000) Alcohol. Alcohol 35: 29–301
Naveau S, Giraud V, Borotto E, et al. (1997) Excess weight risk factor for alcoholic liver disease. Hepatology 25: 108–111
Poynard T, Bedossa P, Opolon P (1997) Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet 349: 825–832
Raynard B, Balian A, Fallik D, et al. (2002) Risk factors of fibrosis in alcohol induced liver disease. Hepatology 35: 635–638
Ratziu V, Munteanu M, Charlotte F, et al. (2003) Fibrogenic impact of high serum glucose in chronic hepatitis C. J Hepatol 39: 1049–1055
N’Kontchou G (2003) Impact of overweight, diabetes mellitus and tobacco on the incidence of HCC in patients with alcohol and viral C cirrhosis. Hepatology 38(Suppl 1): 279A
Roudot-Thoraval F, Bastie A, Pawlotsky JM, et al. (1997) Epidemiological factors affecting the severity of hepatitis Cvirus related liver disease: a french survey of 6664 patients. The study group for prevalence and the epidemiology of hepatitis C virus. Hepatology 26: 485–490
Corrao G, Arico S (1998) Independent and combined action of hepatitis C virus infection and alcohol consumption on the risk of symptomatic liver cirrhosis. Hepatology 27: 914–919
Vento S, Cainelli F (2002) Does hepatitis C virus cause severe liver disease only in people who drink alcohol. Lancet Infect Dis 2: 303–309
Hezode C, Lonjon I, Roudot-Thoraval F, et al. (2003) Impact of moderate alcohol consumption on histological activity and fibrosis in patients with chronic hepatitis C and specific influence on steatosis: a prospective study. Aliment Pharmacol Ther 17: 1031–1037
Monto A, Patel K, Bostrom A, et al. (2004) Risks of a range of alcohol intake on hepatitis C related fibrosis. Hepatology 39: 826–834
Dixon JB, Bhathal PS, O’Brien PE (2001) Nonalcoholic fatty liver disease: predictor of non alcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 121: 91–1000
Ionanou GN, Weiss NS, Kowdley KV, et al. (2003) Is obesity a risk factor for cirrhosis-related death or hospitalization? A population-based cohort study. Gastroenterology 125: 1053–1059
Davies MJ, Baer DJ, Judd JT, et al. (2002) Effect of moderate alcohol intake on fasting insulin and glucose sensitivity and insulin sensitivity in postmenopausal women: a randomized controlled trial. JAMA 287: 2559–2562
Cohen P, Guillevin L (2004) Cryoglobulinemies mixtes, maladies à complexes immuns et maladies systemiques liées au virus de l’hépatite C in Hépatite C. Pawlotsky JM, Dhumeaux D. Éditions EDK. Paris, pp 309–324
Abecassis S, Cribier B, Chosidow O (2004) Manifestations dermatologiques associées à l’infection par le virus de l’hépatite C in Hépatite C. Pawlotsky JM, Dhumeaux D. Éditions EDK. Paris, pp 325–332
Eschwege E (2003) The dysmetabolic syndrome, insulin resistance and increased cardiovascular(CV) morbidity and mortality in type 2 diabetes: aetiological factors in the development of CV complications. Diabetes Metab 29: 19–27
Guide pratique pour faire le point sur votre consommation d’alcool. Intervention auprès des consommateurs excessifs d’alcool. www.inpes.santé.fr
Michaud P, Gache P, Batel P, et al. (2003) Intervention brève auprès des buveurs excessifs. Revue du Prat MG 17: 281–289
Hillaire S, Michaud P (2003) Pourquoi faut-il s’intéresser à la consommation d’alcool des malades atteints d’hépatite C? Hepato-Gastro 10: 14–19
Castera L, Constant A, Foucher J, et al. (2003) Étude des représentations culturelles et des « idées reçues » concernant l’hépatite C chez des patients suivis dans un pôle de référence. Gastroenterol Clin Biol 27(abstract)
Aide à l’arrêt du tabac. Les stratégies thérapeutiques médicamenteuses et non médicamenteuses de l’aide à l’arrêt du tabac. Site web: afssaps.sante.fr
Pessione F, Ramond MJ, Njapoum C, et al. (2001) Cigarette smoking and hepatic lesions in patients with chronic hepatitis C. Hepatology 34: 121–125
Hézode C, Lonjon I, Roudot-Thoraval F, et al. (2003) Impact of smoking on histological liver lesions in chronic hepatitis C. Gut 52: 126–129
Hickman IJ, Clouston AD, MacDonald GA, et al. (2004) Effect of weight reduction on liver histology and biochemistry in patients with chronic hepatitis C. Gut 53: 413–419
Bringer J, Raingeard I, Renard E (2003) Déceler et traiter l’insulinorésistance et ses conséquences. Post’U FMC HGE(Suppl): 198–202, site web: www.fmcgastro.org
Tuomilehto J, Lindström J, Eriksson JG, et al. (2001) Prevention of type2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344: 1343–1350
Linström J, Ilanne-Parikka P, Peltonen ME, et al. (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the finnish diabetes prevention study the lancet 368: 1673–1679
Wing RR, Tate DF, Gorin AA, et al. (2006) A self-regulation program for maintenance of weight loss. N Engl J Med 355: 1563–1571
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Couzigou, P. Comment, en Afrique, gérer les comorbidités en hépatologie?. J Afr Hepato Gastroenterol 1, 63–70 (2007). https://doi.org/10.1007/s12157-007-0014-9
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DOI: https://doi.org/10.1007/s12157-007-0014-9