Evidence for the elimination of viral hepatitis B and C in Egypt: Results of a nationwide survey in 2022

Leading Role of Sofosbuvir/Daclatasvir in Achieving Hepatitis C Elimination in Egypt

Chronic hepatitis C virus (HCV) management has historically been challenging, particularly in Egypt, the country with the highest global disease prevalence. The introduction of direct-acting antivirals (DAAs) has revolutionised treatment, providing high rates of sustained virologic response (SVR) with fewer adverse events compared to previous therapies. In Egypt, the locally produced generics of sofosbuvir/daclatasvir (SOF/DAC) have been integral to the national HCV elimination programme, treating millions effectively and affordably, demonstrating similar efficacy and safety to brand-name drugs. Although not currently present in most international guidelines, this cost-effective regimen offers a viable option for large-scale elimination programmes similar to Egypt's successful experience. This review synthesises real-world Egyptian data and highlights the efficacy and safety of the SOF/DAC combination in various population groups. High sustained virological response (SVR) rates were observed across diverse patient populations, including those with advanced liver disease. However, limitations regarding long-term follow-up, especially HCC surveillance, were identified, underscoring the need for further research. Additionally, the review underscores the success of local Egyptian pharmaceutical policies in reducing treatment costs and securing access for all infected individuals. The Egyptian experience offers valuable insights into the potential for replicating its success, particularly in other high-burden regions.

Assessment of ghrelin serum level and gene polymorphism as a risk factor in progression of chronic viral hepatitis

Hepatocellular carcinoma (HCC) is a significant health concern, ranking as the fourth most common cancer in Egypt and the sixth globally. Research has identified over 300 single nucleotide polymorphisms (SNPs) in the ghrelin gene, with four of these SNPs being associated with pathogenicity. The current work is a pioneer attempt to evaluate the role of Ghrelin gene polymorphism as a risk factor for progression of chronic viral hepatitis to cirrhosis and hepatocellular carcinoma in Egyptian patients. This study was carried out on 80 cases and were allocated into four groups: Group I: apparently healthy individuals, Group II: patients with chronic viral hepatitis, Group III: patients with post-hepatitic cirrhosis, and Group IV: patients with viral hepatitis-related HCC. Serum Ghrelin was measured by ELISA Kit. Molecular detection of Ghrelin rs34911341 and rs696217 were assessed using DNA sequencing. Outcomes showed that in terms of ghrelin gene polymorphism, every group under study had a GG rs34911341. The frequency of rs696217 genotype CA was statistically significantly higher in controls than in cirrhotic and HCC cases. When cirrhosis and HCC cases were compared to controls and chronic active hepatitis cases, the serum ghrelin level decreased statistically significantly. Taken together, there was no relation of ghrelin gene polymorphism in rs34911341 with progression of chronic active hepatitis. Moreover, the frequency of rs696217 genotype CA was increased in controls compared to patients with chronic viral hepatitis and patients with viral hepatitis-related HCC. Compared to controls, liver disease patients had lower serum Ghrelin levels.

The Interplay Between Schistosomiasis and Hepatitis C Virus: Battling on Two Fronts

Abstract

Schistosomiasis is a prevalent health issue in numerous countries in Africa, Asia, and South America. Data regarding the coinfection of schistosomiasis with hepatitis C virus (HCV) is limited, yet this coinfection is prevalent in regions where schistosomiasis is endemic. The extent of the coinfection issue is evident in countries with a high prevalence of both diseases, such as Egypt. Coinfections with schistosomiasis result in more pronounced liver damage compared with an HCV infection alone. Schistosomiasis has been found to disrupt HCV-specific T-cell responses, resulting in high viral load, increased likelihood of HCV chronicity, and accelerated development of comorbidities in individuals with coinfection. Introducing new, directly acting antivirals for HCV treatment resulted in a marked shift in the disease landscape. This shift may have an impact on the incidence of coinfection with schistosomiasis. This review emphasizes the notable influence of schistosomiasis on the vulnerability to HCV coinfection, the gravity of the consequent liver pathology, and the effectiveness of HCV antiviral therapy.

Hepatitis C Elimination in Egypt: Story of Success

Egypt has long been overwhelmed by the hepatitis C virus (HCV) infection, and it used to be the country with the world's highest prevalence rates. The disease had been a significant public health problem, affecting millions of Egyptians and posing severe economic and social challenges. By the early 2000s, it was estimated that around 10% of the Egyptian population was infected with HCV. However, in recent years, with the availability of direct-acting antiviral therapies, the country has made enormous steps in combating this public health threat. The combination of innovative health strategies and political will enabled Egypt to establish a successful model of care for HCV management and to be the first country to eliminate hepatitis C, setting a model for the rest of the world. In 2023, Egypt became the first country to fulfill the World Health Organization's set programmatic criteria of reduction of hepatitis C incidence and mortalities to levels close to elimination of disease or achieve the "gold tier" status on the path to disease elimination.

The COVID-19 Pandemic Affected Hepatitis C Virus Circulation and Genotypic Frequencies-Implications for Hepatitis C Prevention, Treatment and Research

Hepatitis C is regarded as a global health issue caused by hepatitis C virus (HCV) infection. HCV is targeted for elimination by 2030 as a global public health goal. However, the COVID-19 pandemic has changed human circulation and prevented access to diagnostics and treatment to many other diseases, including hepatitis C. COVID-19 impacted HCV global elimination efforts with implications not fully comprehended yet. The high genetic variability in HCV makes the development of vaccines and pan-genotypic drug therapies a difficult task. Changes in the dynamics of HCV impose new challenges for public health and opportunities for future research. Meta-analysis, the follow up of new cases and sampling of HCV patients compared with previously available data are options for investigating the possible changes. The determination of HCV genotypes and subtypes is important for understanding viral dynamics and treatment; therefore, the changes in genotype and subtype prevalences can directly affect such processes. Recent results in the literature already suggest changes in HCV dynamics during the COVID-19 pandemic, both considering viral circulation and differential genotypic frequencies in distinct geographic areas. In this context, we propose a further examination of these trends using different approaches to provide support for the hypothesis that the COVID-19 pandemic affected HCV circulation, since these findings would have important implications for hepatitis C prevention, treatment and research.