Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Background & Aims
In 2015, a national Egyptian health issue survey was conducted to describe the prevalence of hepatitis C virus (HCV) infection. In this paper, we describe the HCV burden in 2015, compare the results with the national survey conducted in 2008, and discuss the implications of the new findings on prevention of HCV in Egypt.

Methods
A multistage probability sampling approach was used, similar to the national demographic survey conducted in 2008. More than 90% of sampled individuals complied with the interview and provided blood samples.

Results
In the 15–59-year age groups, the prevalence of HCV antibody was found to be 10.0% (95% CI 9.5–10.5) and that of HCV RNA to be 7.0% (95% CI 6.6–7.4). In children, 1–14 years old, the prevalence of HCV antibody and HCV RNA were 0.4% (95% CI 0.3–0.5) and 0.2% (95% CI 0.1–0.3) respectively. Approximately, 3.7 million persons have chronic HCV infection in the age group 15–59 in 2015. An estimated 29% reduction in HCV RNA prevalence has been seen since 2008, which is largely attributable to the ageing of the group infected 40–50 years ago during the mass schistosomiasis treatment campaigns. Prevention efforts may have also contributed to this decline, with an estimated 75% (95% CI 6–45) decrease in HCV incidence in the 0–19 year age groups over the past 20 years.

Conclusions
These findings can be used to shape future HCV prevention policies in Egypt.

/pdf/the-prevalence-of-hepatitis-c-virus-infection-in-egypt-2015-4nr9sv2non.pdf

The prevalence of hepatitis C virus infection in Egypt 2015: implications for future policy on prevention and treatment

Screening Program to Eliminate Hepatitis C in Egypt In 2018, the Egyptian government initiated a massive hepatitis C screening and treatment program. The Ministry of Health set the goal of screenin...

https://www.nejm.org/doi/pdf/10.1056/NEJMsr1912628

Screening and Treatment Program to Eliminate Hepatitis C in Egypt

Hepatitis C virus (HCV) infection is a major health problem in Egypt as the nation bears the highest prevalence rate worldwide. This necessitated establishing a novel model of care (MOC) to contain the epidemic, deliver patient care and ensure global treatment access. In this review, we describe the process of development of the Egyptian model and future strategies for sustainability. Although the magnitude of the HCV problem was known for many years, the HCV MOC only came into being in 2006 with the establishment of the National Committee for Control of Viral Hepatitis (NCCVH) to set up and implement a national control strategy for the disease and other causes of viral hepatitis. The strategy outlines best practices for patient care delivery by applying a set of service principles through identified clinical streams and patient flow continuums. The Egyptian national viral hepatitis treatment programme is considered one of the most successful and effective public health programmes. To date, more than one million patients were evaluated and more than 850 000 received treatment under the umbrella of the programme since 2006. The NCCVH has been successful in establishing a strong infrastructure for controlling viral hepatitis in Egypt. It established a nationwide network of digitally connected viral hepatitis-specialized treatment centres covering the country map to enhance treatment access. Practice guidelines suiting local circumstances were issued and regularly updated and are applied in all affiliated centres. This review illustrates the model and the successful Egyptian experience. It sets an exemplar for states, organizations and policy-makers setting up programmes for care and management of people with hepatitis C.

National treatment programme of hepatitis C in Egypt: Hepatitis C virus model of care

Management of hepatitis C virus genotype 4: Recommendations of An International Expert Panel

Objectives: The recurrence of hepatitis C virus infection after liver transplant is common and may endanger both graft and patient survival. We investigated the frequency and outcome of and risk factors for the recurrence of that virus after livingdonor liver transplant in hepatitis C virus positive recipients. Materials and Methods: Seventy-four adult hepatitis C virus positive subjects were monitored for 36 months after living-donor liver transplant and demographic and laboratory data for the recipients and donors were evaluated. Recurrent hepatitis C virus infection was diagnosed on the basis of viral replication revealed by polymerase chain reaction after transplant, elevated levels of transaminases, and the results of liver biopsy. Results: Hepatitis C virus recurrence was identified in 31.1% of the patients studied. Histopathologic recurrence was mild, and 91% of the subjects had a fibrosis score of ≤ F2. No recipient exhibited cirrhosis or clinical decompensation during followup. Recurrent hepatitis C virus infection was associated with pretransplant and posttransplant *

Recurrence of hepatitis C virus (genotype 4) infection after living-donor liver transplant in Egyptian patients.

Achieving global elimination of hepatitis C virus requires a substantial scale‐up of testing. Point‐of‐care HCV viral load assays are available as an alternative to laboratory‐based assays to promote access in hard to reach or marginalized populations. The diagnostic performance and lower limit of detection are important attributes of these new assays for both diagnosis and test of cure. Therefore, our objective was to determine an acceptable LLoD for detectable HCV viraemia as a test for cure, 12 weeks post‐treatment (SVR12). We assembled a global data set of patients with detectable viraemia at SVR12 from observational databases from 9 countries (Egypt, the United States, United Kingdom, Georgia, Ukraine, Myanmar, Cambodia, Pakistan, Mozambique) and two pharmaceutical‐sponsored clinical trial registries. We examined the distribution of HCV viral load at SVR12 and presented the 90th, 95th, 97th and 99th percentiles. We used logistic regression to assess characteristics associated with low‐level virological treatment failure (defined as <1000 IU/mL). There were 5973 cases of detectable viraemia at SVR12 from the combined data set. Median detectable HCV RNA at SVR12 was 287,986 IU/mL. The level of detection for the 95th percentile was 227 IU/mL (95% CI 170–276). Females and those with minimal fibrosis were more likely to experience low‐level viraemia at SVR12 compared to men (adjusted odds ratio AOR = 1.60 95% confidence interval [CI] 1.30–1.97 and those with cirrhosis (AOR = 1.49 95% CI 1.15–1.93). In conclusion, an assay with a level of detection of 1000 IU/mL or greater may miss a proportion of those with low‐level treatment failure.

/pdf/determining-the-lower-limit-of-detection-required-for-hcv-kkuljdgj.pdf

Determining the lower limit of detection required for HCV viral load assay for test of cure following direct‐acting antiviral‐based treatment regimens: Evidence from a global data set

The current and future disease burden of chronic hepatitis C virus infection in Egypt.

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Recurrence of hepatitis C virus (genotype 4) infection after living-donor liver transplant in Egyptian patients.

Determining the lower limit of detection required for HCV viral load assay for test of cure following direct‐acting antiviral‐based treatment regimens: Evidence from a global data set

The current and future disease burden of chronic hepatitis C virus infection in Egypt.