Expected increase in hepatitis C-related mortality in Egypt due to pre-2000 infections

doi:10.1016/j.jhep.2005.08.008

Journal of Hepatology

Volume 44, Issue 3, March 2006, Pages 455-461

https://doi.org/10.1016/j.jhep.2005.08.008 Get rights and content

Background/Aims

Egypt has the highest prevalence of Hepatitis C Virus (HCV) in the world, apparently due to mass parenteral antischistosomal therapy. Estimating the future burden of HCV in Egypt is important to support health policies to combat the epidemic.

Methods

A previous back calculation model was adapted to the situation in Egypt. It combines a model of the natural history of HCV infections with available epidemiological data to back calculate the past HCV incidence from observed 1980–1999 hepatocellular carcinoma (HCC) mortality. In turn, the HCV-related mortality burden is projected in the future due to pre-2000 infections.

Results

Compared with the observed number of HCC deaths in 1999, the model predicts a 3.5-fold increase in this mortality in the next 20 years. Globally, the model predicts a 2.4-fold increase in the HCV-related mortality. These predictions do not take into account the new infections that may occur after 2000, which would still increase the estimated future mortality burden.

Conclusions

HCV-related mortality is expected at least to double in the next 20 years. The use of antiviral therapies can lower these predictions. Efficient prevention policies are needed to avoid these predictions being exceeded.

Introduction

The World Health Organization has declared hepatitis C a global health problem, with approximately 3% of the world's population infected with the hepatitis C virus (HCV). There are more than 170 million HCV chronic carriers at risk of developing liver cirrhosis and/or hepatocellular carcinoma (HCC) [1], [2]. Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, ranging from 6 to 28% [3], [4], [5], [6] with an average of approximately 13.8% in the general population. These estimates lead roughly to 9 million persons who have acquired HCV infection and 7 million who have HCV chronic liver disease in 1996.

In Egypt, the major route of exposure to HCV appears to be the mass parenteral antischistosomal treatment (PAT) [3], with more than 35 million injections for more than 6 million Egyptians given over a 20-year period (1960–1980). Although schistosomiasis was the major public health problem in the past, HCV has become the most important problem in Egypt [3]. After termination of the PAT program (mid-1980s), transmission of HCV continued through other routes (tattooing, circumcision using unsterilized material, etc.). The objectives of this paper are to reconstruct the past history of HCV infections, estimate the current burden due to past infections and estimate the future burden due to current infections.

Section snippets

Materials and methods

A previously published back calculation model [7], [8] was adapted to the situation in Egypt. It combines a Markov model of the natural history of HCV infection with available epidemiological data to back calculate the annual HCV incidence in the past (the infection curve) from observed HCC mortality. In turn, the current and future burdens of HCV-related mortality are projected.

Model selection

Among the 24 models tested, 14 provided acceptable fits to the data and were selected for further analysis. Two models led to unsatisfactory fits and eight were rejected leading to estimates of P_DLF below 1% which is not realistic [21]. Fig. 2 shows the best fit obtained with the baseline assumptions. Table 1 shows the estimated annual probabilities of progression from chronic hepatitis to cirrhosis, from cirrhosis to liver failure death and from cirrhosis to HCC. The range was obtained from

Discussion

The model predicts that the total HCV-related mortality will increase by a 2.4-fold in the next 20 years. This figure is obtained without taking into account the possibility of an efficient therapy available in the next years in Egypt. Indeed, preliminary results of clinical trials indicate that antiviral response rate for patients infected with genotype 4 (the dominant genotype in Egypt) falls within the range observed with other genotypes [22].

The model traces the main source of HCV epidemic

Acknowledgements

This study has been funded by a European Commission INCOMED grant (contract ICA3-CT-2000-30011).

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Expected increase in hepatitis C-related mortality in Egypt due to pre-2000 infections

Background/Aims

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Model selection

Discussion

Acknowledgements

Lancet

Hepatology

J Hepatol

Hepatology

Lancet

Gastroenterology

Hepatitis C

Wkly Epidemiol Rec

Hepatitis C: global prevalence

Wkly Epidemiol Rec

Hepatitis C virus infection at Sharkia Governorate, Egypt: seroprevalence and associated risk factors

J Egypt Soc Parasitol

Hepatitis C in a community in Upper Egypt: I. Cross-sectional survey

Am J Trop Med Hyg

Modeling the HCV epidemic in France

Hepatology

Markov models in medical decision making: a practical guide

Med Decis Making