Hepatitis C in Egypt – past, present, and future
Authors Elgharably A, Gomaa AI, Crossey MME, Norsworthy PJ, Waked I, Taylor-Robinson SD
Received 8 August 2016
Accepted for publication 28 September 2016
Published 20 December 2016 Volume 2017:10 Pages 1—6
DOI https://doi.org/10.2147/IJGM.S119301
Received 8 August 2016
Accepted for publication 28 September 2016
Published 20 December 2016 Volume 2017:10 Pages 1—6
DOI https://doi.org/10.2147/IJGM.S119301
Abstract: Hepatitis C viral infection is endemic in Egypt with the highest prevalence rate in the world. It is widely accepted that the implementation of mass population antischistosomal treatment involving administration of tartar emetic injections (from 1950s to 1980s) led to widespread infection. What is less well known, however, is that these schemes were implemented by the Egyptian Ministry of Health on the advice of the World Health Organization. There has been a spectrum of treatments to target the public health disaster represented by the hepatitis C problem in Egypt: from the use of PEGylated interferon to the recent use of direct acting antiviral drugs. Some new treatments have shown >90% efficacy. However, cost is a key barrier to access these new medicines. This is coupled with a growing population, limited resources, and a lack of infection control practices which means Egypt still faces significant disease control issues today.
Conclusion/Discussion Only
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Alternative treatments and future steps
It is clear that there is evidence of some good foundations for tackling the widespread prevalence of HCV in Egypt. At the time of writing, the development of effective DAAs has shown up to 90% efficacy against HCV genotype 4, and such treatment has been able to produce excellent SVR results in the Egyptian context. There is less ignorance and lack of awareness of the need to properly sterilize equipment and medical instruments than there has been in the past, although public awareness campaigns still need to be conducted, including to allied health care professionals. From a historical perspective, the Egyptian population has become much more aware of the threats associated with swimming and utilizing canal water which has led to a decrease in incidence rates of schistosomiasis in parallel. Effort must now be concentrated on treating the existing HCV patients, who are suffering from the failed treatments initiatives of the past.
The Egyptian Ministry of Health must take a two-pronged approach to tackling this disease. Currently, there are established DAAs that have the portent to eliminate HCV. In addition, local pharmaceutical companies should be aided in developing drug generic versions in order to make direct acting antiviral drugs more accessible for those who have not been able to gain access to treatment through governmentally subsidized schemes.
It is important to realize, however, that widespread DAA treatment will not solve all the associated problems of the HCV epidemic in Egypt. The complications of decompensated cirrhosis and hepatocellular carcinoma present a massive burden to Egyptian society and they still need to be addressed with adequate health care resource allocation.
Egypt has all the potential tools to tackle its HCV crisis. What is needed is ring-fenced governmental funding to enforce treatment policy, as well as clear medical and public health guidance in order to target treatment effectively. At the same time, the Egyptian Ministry of Health must continue to invest in research and development for the best emerging treatments to be implemented. However, it is important not to forget the essentials of education, infection control, equipment sterilization, and risk aversion to stop further growth of those who continue to become newly infected.
Alternative treatments and future steps
It is clear that there is evidence of some good foundations for tackling the widespread prevalence of HCV in Egypt. At the time of writing, the development of effective DAAs has shown up to 90% efficacy against HCV genotype 4, and such treatment has been able to produce excellent SVR results in the Egyptian context. There is less ignorance and lack of awareness of the need to properly sterilize equipment and medical instruments than there has been in the past, although public awareness campaigns still need to be conducted, including to allied health care professionals. From a historical perspective, the Egyptian population has become much more aware of the threats associated with swimming and utilizing canal water which has led to a decrease in incidence rates of schistosomiasis in parallel. Effort must now be concentrated on treating the existing HCV patients, who are suffering from the failed treatments initiatives of the past.
The Egyptian Ministry of Health must take a two-pronged approach to tackling this disease. Currently, there are established DAAs that have the portent to eliminate HCV. In addition, local pharmaceutical companies should be aided in developing drug generic versions in order to make direct acting antiviral drugs more accessible for those who have not been able to gain access to treatment through governmentally subsidized schemes.
It is important to realize, however, that widespread DAA treatment will not solve all the associated problems of the HCV epidemic in Egypt. The complications of decompensated cirrhosis and hepatocellular carcinoma present a massive burden to Egyptian society and they still need to be addressed with adequate health care resource allocation.
Egypt has all the potential tools to tackle its HCV crisis. What is needed is ring-fenced governmental funding to enforce treatment policy, as well as clear medical and public health guidance in order to target treatment effectively. At the same time, the Egyptian Ministry of Health must continue to invest in research and development for the best emerging treatments to be implemented. However, it is important not to forget the essentials of education, infection control, equipment sterilization, and risk aversion to stop further growth of those who continue to become newly infected.
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