The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis

Abstract

Background: Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. Our study's objective was to delineate the evidence on the epidemiology of HCV infection among the different population groups in Egypt, and to draw analytical inferences about the nature of HCV transmission in this country.

Methods: We conducted a systematic review of all data on HCV prevalence and incidence in Egypt following PRISMA guidelines. The main sources of data included PubMed and Embase databases. We also used a multivariate regression model to infer the temporal trend of HCV prevalence among the general population and high risk population in Egypt.

Results: We identified 150 relevant records, four of which were incidence studies. HCV incidence ranged from 0.8 to 6.8 per 1,000 person-years. Overall, HCV prevalence among pregnant women ranged between 5-15%, among blood donors between 5-25%, and among other general population groups between 0-40%. HCV prevalence among multi-transfused patients ranged between 10-55%, among dialysis patients between 50-90%, and among other high risk populations between 10% and 85%. HCV prevalence varied widely among other clinical populations and populations at intermediate risk. Risk factors appear to be parenteral anti-schistosomal therapy, injections, transfusions, and surgical procedures, among others. Results of our time trend analysis suggest that there is no evidence of a statistically significant decline in HCV prevalence over time in both the general population (p-value: 0.215) and high risk population (p-value: 0.426).

Conclusions: Egypt is confronted with an HCV disease burden of historical proportions that distinguishes this nation from others. A massive HCV epidemic at the national level must have occurred with substantial transmission still ongoing today. HCV prevention in Egypt must become a national priority. Policymakers, and public health and medical care stakeholders need to introduce and implement further prevention measures targeting the routes of HCV transmission.

Figure 1

Flow of article selection for the HCV prevalence and incidence in Egypt search. This chart, adapted from the PRISMA 2009 flow diagram, displays the flow of article selection for the HCV incidence and prevalence in Egypt search of scientific databases, namely PubMed and Embase.

Figure 2

Hepatitis C virus (HCV) prevalence among the general population and populations at direct or high risk in Egypt, in studies conducted pre- and post-2001. A: Graph depicting HCV prevalence among different general population groups. B: Graph depicting HCV prevalence among different high/direct risk populations. In this figure, we included only stratified HCV prevalence measures, if these stratified measures were available. Otherwise, we included the overall prevalence measures in the study.

Figure 3

Hepatitis C virus (HCV) prevalence among populations at indirect or intermediate risk and special clinical populations in Egypt, in studies conducted pre and post the 2001. A: Graph depicting HCV prevalence among different populations at indirect or intermediate risk in Egypt. B: Graph depicting HCV prevalence among different special clinical populations¹ in Egypt. In this figure, we included only stratified HCV prevalence measures, if these stratified measures were available. Otherwise, we included the overall prevalence measures in the study. ¹Acronyms: BC: bladder cancer, CLD: chronic liver disease, CRF: chronic renal failure, CV: cutaneous vasculitis, GIB: gastrointestinal bleeding, GN: glomerulonephritis, HCC: hepatocellular carcinoma, HCCA:hilarcholangiocarcinoma, HL: Hodgkin’s lymphoma, KTP: kidney transplant patients, LD: liver diseae, LP:lichen planus, MDS: myelodysplastic syndrome NHL: non-Hodgkin’s lymphoma, RHD: rheumatic heart disease, SLE: systematic lupus erthymatosus.

Figure 4

Time trend of hepatitis C prevalence among the different general population subgroups in Egypt.