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www.nature.com/scientificreports
OPEN
Received: 4 July 2017 Accepted: 4 December 2017 Published: xx xx xxxx
Characterizing hepatitis C virus epidemiology in Egypt: systematic reviews, meta-analyses, and metaregressions Silva P. Kouyoumjian1, Hiam Chemaitelly 1 & Laith J. Abu-Raddad1,2 Egypt is the most affected nation by hepatitis C virus (HCV) and needs a comprehensive characterization of HCV epidemiology to inform the scale-up of treatment and prevention programs. Systematic reviews, meta-analyses, and meta-regressions were conducted. A total of 25 incidence, 259 prevalence, and 47 genotype studies were identified. Incidence and prevalence levels were high across all populations. Genotype 4 accounted for 94.1% of infections with a relative Shannon Diversity Index of only 14.4%. Pooled mean HCV prevalence was estimated at 11.9% (95% CI = 11.1–12.6%) among the general population, 55.6% (95% CI = 49.4–61.7%) among populations at high risk, 14.3% (95% CI = 10.3–18.8%) among populations at intermediate risk, 56.0% (95% CI = 50.4–61.6%) among populations with liver-related conditions, and 35.0% (95% CI = 27.3–43.1%) among special clinical populations. Mean HCV viremic rate was estimated at 66.7% (95% CI = 61.7–71.5%). Metaregression indicated 6% lower odds for HCV prevalence for each one-year increment in publication year (AOR = 0.94; 95% CI = 0.92–0.96). HCV prevalence is high with evidence for ongoing transmission mainly through healthcare. Genotype diversity is low with genotype 4 dominance. Two-thirds of antibody-positive Egyptians are chronically infected and need treatment. Clinical populations should be prioritized for screening. Despite the large-scale epidemic, prevalence appears to be declining rapidly consistent with a contracting epidemic. Viral hepatitis was estimated to be the 7th leading cause of mortality globally1. About half of this mortality is attributed to hepatitis C virus (HCV), a primary cause for liver fibrosis, cirrhosis and cancer2,3. The recent development of highly efficacious oral direct-acting antivirals (DAAs) provides opportunities for reducing HCV disease burden and its onward transmission, with the potential for eliminating this blood-borne virus as a public health concern4–7. The World Health Organization (WHO) has recently formulated the ‘Global Health Sector Strategy on Viral Hepatitis, 2016–2021’8 with service coverage targets to eliminate HCV as a public health threat by 20308,9. Action to combat viral hepatitis has now been integrated into the United Nations’ 2030 Agenda for Sustainable Development10. One of the countries most affected by HCV is Egypt. The Egypt Demographic and Health Surveys (EDHS) measured antibody prevalence among the adult population aged 15–59 years at 14.7%11 in 2009 and at 10.0%12 in 2015—substantially higher than global levels2,3,13. To attend to this challenge, Egypt developed a national strategy for HCV control and established HCV prevention and treatment programs14–16. Following successful negotiations for 99% discounted DAA prices17, Egypt launched an ambitious national HCV treatment program aiming to treat over 250,000 chronically infected individuals per year, with the goal of achieving a national chronic infection prevalence of
