الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Estimates place the number of HCV infected individuals at approximately 170 million, representing nearly 3% of the world’s population. Viral hepatitis is the most significant public health problem facing Egypt today. HCV prevalence rates in the general population are estimated at between 10% and 15% in rural areas, with some age groups suffering from prevalence rates of up to 50%. Since 2006, Egypt has made great progress in the management of viral hepatitis in establishing a National Committee for the Control of Viral Hepatitis with 23 affiliated viral hepatitis treatment units distributed all over the country as a part of Viral Hepatitis National Treatment Program launched in 2008. Between 2006 and 2012, more than 220 000 HCV patients were treated in National Treatment Centers and HIO centers. Currently, Egyptians being treated for HCV receive 48 weekly subcutaneous doses of pegylated interferon with twice daily doses of ribavirin, though new treatment regimen with sofosbuvir is on its way for implementation.
The association between T2DM and CHC was first reported in 1994 by Allison et al, who observed that the prevalence of T2DM was significantly higher in those with HCV-related cirrhosis than those with cirrhosis resulting from other liver diseases. Evidence showing a direct diabetogenic effect of HCV per se was studied. Also immunologic effect is known, through induction of a Th1 lymphocyte immune-mediated response which leads to activation of the tumor necrosis factor (TNF)-α and elevation of interleukin-6 levels. Insulin carries its biological effects through phosphorylation of the substrate of the insulin receptor 1 (IRS-1) and 2 (IRS-2). A high TNF-α level was considered to be one of the bases of insulin resistance (IR), which act by disturbing tyrosine phosphorylation of insulin receptor substrate (IRS)-1, a central molecule of the insulin-signaling cascade.