Review The current and future disease burden of chronic hepatitis C virus infection in Egypt Imam Waked a,⇑ , Waheed Doss b , Manal Hamdy El-Sayed c , Chris Estes d , Homie Razavi d , Gamal Shiha e , Ayman Yosry b , Gamal Esmat b a National Liver Institute, Shebeen El Kom, Egypt b Cairo University, Cairo, Egypt c Ain Shams University, Cairo, Egypt d Center for Disease Analysis (CDA), Louisville, CO, USA e Mansoura University, Mansoura, Egypt article info Article history: Received 20 April 2014 Accepted 20 April 2014 Available online xxxx abstract Ó 2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. Introduction Hepatitis C virus (HCV) infection is a major public health bur- den in Egypt [1,2]. A number of studies have characterised HCV infection rate in Egypt [3,1,4,5] but they have focused on quantify- ing the prevalence or total number of HCV infections. The future outlook of the disease burden is not known. This, however, is expected to increase as the infected population ages [6,7]. A number of new treatment options have become, and will become, available in the immediate future, with much higher effi- cacy (cure rates >90%) compared to the current standard of care. The policy-makers will need reliable projection data to evaluate how to utilise these therapies most efficiently. The aim of this review is to analyse current number of infec- tions in different disease stages, and to estimate the future burden of HCV disease if the current infection rate, treatment paradigm and response rate are continued. The current and future therapies are reviewed, and a model is used to examine the impact of differ- ent treatment strategies on the future disease burden. The objec- tive is to analyse the impact of changes in treatment and response rate on the disease burden as a possible method for dis- ease control. Current epidemiology and disease burden Egypt has the highest prevalence rate of HCV in the world [8,9]. Nosocomial transmission has been [10], and probably still is [11], the most common route for new infections. In particular, widespread parenteral treatment of schistosomiasis in earlier dec- ades resulted in high levels of HCV transmission [12]. Estimates for prevalence are based upon data reported from the 2008 Egypt Demographic and Health Survey (EDHS), a nationally representative sample that included participants in all major Egyp- tian regions [13], where seroprevalence and viraemia estimates were reported by a 5-year age group and gender for individuals aged 15–59 years. Total anti-HCV prevalence was 14.7%, and vira- emia was 9.8% [13]. In this review, to estimate the prevalence in the population younger than 15 years in 2008, an exponential decline in viraemic prevalence was trended. Prevalence in those aged >59 years was set equal to prevalence in those aged 55– 59 years (Fig. 1). The prevalence of HCV antibody positivity in 2008 after adjusting for younger and older individuals was esti- mated at 12% [14]. However, only two thirds of the infected popu- lation was viraemic in the EDHS, resulting in an all age group viraemic prevalence of 8.5% in 2008. A mathematical model described elsewhere [14] was used to estimate the 2013 HCV infected populations. After taking into con- sideration mortality, new infections and cured patients, the 2013 viraemic prevalence was estimated at 7.3% (Table 1). Although the viraemic prevalence dropped by 1.2%, the actual number of cases decreased by only three hundred thousand cases. The increase in population in the last five years was responsible for some of the drop in estimated HCV prevalence [15]. The genotype distribution in Egypt is mainly genotype 4 (HCV- G4) which is responsible for more than 90% of the infections, with the remaining due to HCV-G1 [16–18] (Table 1). According to the EDHS, only 1.4% (1,052,000 antibody positive or 713,000 viraemic individual) of Egyptians had received a posi- tive HCV diagnosis in 2008 [13]. According to estimates and expert http://dx.doi.org/10.1016/j.ajg.2014.04.003 1687-1979/Ó 2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. ⇑ Corresponding author. E-mail address: iwaked@liver-eg.org (I. Waked). Arab Journal of Gastroenterology xxx (2014) xxx–xxx Contents lists available at ScienceDirect Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg Please cite this article in press as: Waked I et al. The current and future disease burden of chronic hepatitis C virus infection in Egypt. Arab J Gastroenterol (2014), http://dx.doi.org/10.1016/j.ajg.2014.04.003