Hepatitis C virus (HCV) infection is a major public health burden in Egypt, where it bears the highest prevalence rate in the world.
According to NCBI, 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 economic burden of chronic HCV infection to the Egyptian economy, including direct (HCV-related health care costs) and indirect costs (disability and loss of life), 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. Chronic infection with HCV is the leading cause of end-stage liver disease, hepatocellular carcinoma (HCC) and liver-related death in Egypt.
HCV causes chronic hepatitis in 60 percent–80 percent of the patients, and 10 percent–20 percent of those patients develop cirrhosis over 20–30 years of HCV infection. About 1 percent–5 percent of the patients with liver cirrhosis may develop liver cancer and 3 percent–6 percent may decompensate during the following 20–30 years. The risk of death in the following year after an episode of decompensation is between 15 percent and 20 percent.
The national treatment strategy for control of HCV infection in Egypt was set by the National Committee for Control of Viral Hepatitis (NCCVH) which was established by the MoH in 2006, in response to the magnitude of the HCV problem and burden of disease in Egypt.
This committee had an advisory board of volunteer hepatology and epidemiology professors and included international experts from Pasteur Institute, Paris, and the University of California, San Francisco.
The large national treatment program to treat patients with HCV infection was feasible and manageable. Scaling up of the treatment program was possible with the availability of more medications, with more affordability through both allocating more resources and decreasing costs, with the decision to treat all stages of fibrosis and with removing the requirement of strict fibrosis assessment.
Each country’s availability of resources, availability of medication and expected number of patients will determine the initial treatment and prioritization strategies. In the Egyptian program, rapid adaptation to changes in availability and modification of the guidelines were a key to the success in including and managing this huge number of patients in this short time.
With limited resources and limited availability of drugs, choosing liver fibrosis as a priority parameter for mass treatment projects was the best recourse for national program in order to prioritize patients in whom therapy is urgently needed.
The treatment of hundreds of thousands of patients with >90 percent SVR rates in a short time will hopefully lead to achieving the target of HCV disease control and eventual elimination in Egypt. How far will successful therapy change the epidemiology of the disease remains to be seen.