Hepatitis C infection in Egypt: prevalence, impact and management strategies

Hepatic Medicine: Evidence and Research Dovepress open access to scientific and medical research REVIEW Hepatic Medicine: Evidence and Research downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Open Access Full Text Article Hepatitis C infection in Egypt: prevalence, impact and management strategies This article was published in the following Dove Press journal: Hepatic Medicine: Evidence and Research 15 May 2017 Number of times this article has been viewed Asmaa Gomaa 1 Naglaa Allam 1 Aisha Elsharkway 2 Mohamed El Kassas 3 Imam Waked 1 1 Hepatology Department, National Liver Institute, Shebeen EL Kom, 2 Endemic Medicine Department, Faculty of Medicine, Cairo University, 3 Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt Video abstract Prevalence Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: http://youtu.be/Rx-o8QknkOU Correspondence: Imam Waked Hepatology Department, National Liver Institute, 108 Tahrir street, Dokki, Giza, Shebeen EL Kom 12311, Egypt Tel +20 23 336 8090 Fax +20 48 223 4586 Email The prevalence of hepatitis C virus (HCV) infection in Egypt is the highest in the world.1 This became apparent early on, soon after the discovery of HCV. Seroprevalence among Egyptian blood donors in the Kingdom of Saudi Arabia was found to be much higher than that in blood donors from all other nationalities.2 Since then, it became apparent that HCV infection was widespread among Egyptians and that it was the main cause of liver disease in the country. Until the HCV epidemic became apparent, schistosomiasis was the most important public health problem in Egypt.3 In 1918, Christopherson made the discovery that injections with the antimony salt, tartar emetic, could induce a cure.4 Mass treatment of the parasite was then introduced, and from the 1950s to the 1980s, nationwide mass anti-schistosomal therapy with a series of intravenous injections of tartar emetic was adopted by the Egyptian Ministry of Health (MOH) with the advice and support of the World Health Organization (WHO).5,6 More than 2 million injections were given annually to an average of 250,000 patients. Over the 18 years of treatment, 36 million injections were administered to >6 million 17 submit your manuscript | www.dovepress.com Hepatic Medicine: Evidence and Research 2017:9 17–25 Dovepress © 2017 Gomaa et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/HMER.S113681 Powered by TCPDF (www.tcpdf.org) Abstract: Hepatitis C virus (HCV) infection is a major public health burden in Egypt, where it bears the highest prevalence rate in the world. Estimates for prevalence are based upon data reported from the 2008 and 2015 Egypt Demographic Health Surveys. In this review, we demonstrate the prevalence results of both surveys and analyze the difference in the results. The overall HCV prevalence is estimated to be declining. However, the clinical impact of chronic HCV infection is expected to grow considerably. A mathematical model shows that by increasing the rate of treatment, the expected number of patients will decline significantly in 2030. The current and expected future burden of chronic HCV infection to the Egyptian economy, including direct and indirect costs due to disability and loss of lives, has been estimated and discussed in this review. The economic burden will continue to grow, but a model shows that the introduction of highly effective therapies will result in a significant reduction in the cumulative total economic burden of HCV by 2030. In recognition of the HCV tremendous health and economic burden, the Egyptian government established the National Committee for Control of Viral Hepatitis to implement an integrated nationwide strategy to provide patient care and ensure global treatment access. This review illustrates the epidemiological and disease burden aspects of HCV in Egypt in addition to introducing the national plan and program for managing HCV, which has been successful so far in treating a large number of patients, with the aim of achieving disease control and eventual elimination in Egypt. Keywords: hepatitis C in Egypt, prevalence, HCV burden, treatment strategy Dovepress A 35 HCV antibody prevalence (%) people, almost all with unsterilized and shared syringes and needles. This represents the largest ever iatrogenic spread of blood-borne infection.6 Several national studies over time showed very high seroprevalence,7–10 and a large study in the Nile Delta in 1996 found a seroprevalence of 24% and viremic prevalence of 15% among 3,999 examined adults and children, with seroprevalence in adults >40%.11 The Demographic Health Survey (DHS) of 200812 showed a national seroprevalence of 14.7% among those aged between 15 and 59 years, with viremic prevalence of 9.7% in this age group that increased with age and was higher in males than in females in all age groups studied (Figure 1). In a modeling study, to estimate the prevalence in those aged <15 years in 2008, an exponential decline in viremic prevalence was trended, and prevalence in those aged >59 years was set by the authors to be equal to that in those aged 59 years. Using this model, it was estimated that the national seroprevalence in 2008 was 12.5% and the viremic prevalence was 8.5%, and that 6.3 (5.7–7.0) million people were living with HCV infection.13 A mathematical model was used to estimate the 2014 prevalence. Assuming that 65,000 patients were treated annually with pegylated (PEG) interferon and ribavirin (RBV) 30 33 25 Men Women 20 17 10 10 5 0 4 2 3 5 3 11 9 13 15 31 24 23 15 B 30 25 6 27.8 23.7 Men Women 20 16.1 15 10.8 10 7.1 5 0 0.8 3.1 1.5 4.7 1.9 3.2 6.9 5.3 17.7 12.4 10.4 7.3 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 Age-group (years) Figure 1 Percent of men and women with hepatitis C antibody by age in Egypt in (A) 200812 and (B) 2015.15 Abbreviation: HCV, hepatitis C virus. 18 Powered by TCPDF (www.tcpdf.org) submit your manuscript | www.dovepress.com Dovepress with a sustained virologic response (SVR) rate of ~50%, that 32,000 patients were cured, that an estimated 150,000 new infections occur annually leading to 100,000 chronic HCV infections and that 150,000 persons with HCV die (120,000 of causes o (...truncated)