HCV and HEV: two players in an Egyptian village, a study of prevalence, incidence, and co-infection

Abstract

The highest recorded hepatitis C virus (HCV) prevalence worldwide is in Egypt. A high prevalence of hepatitis E virus (HEV) in chronic liver disease has been reported. The aim of this study was to study prevalence, incidence, and outcome of HCV infection in an Egyptian Nile Delta village and the relation between HEV infection and HCV-related chronic hepatic affection. This prospective cohort study included 2085 Nagreej village residents. Mass HCV screening was conducted and testing for HEV antibodies among HCV-infected patients performed. The annual incidence of HCV was recorded. Five hundred five (24.22%) of the tested villagers were positive for HCV RNA. Prevalence escalated with age and male sex. The main recorded risk factors were a history of surgery, dental procedures, hospitalization, blood transfusion, and antischistosomal treatment. HEV IgG antibody was positive in 71.4% of individuals with chronic HCV and 96.1% with advanced liver disease (cirrhosis ± hepatocellular carcinoma (HCC)). After 1 year, 29 of the 1390 HCV Ab negative villagers had a positive HCV PCR, placing an annual incidence of new HCV infections at 2.09%. The Egyptian HCV prevalence remains high with infection particularly among the elderly. The annual incidence in a small Nile Delta village is 2.086%. HCV-HEV co-infection may lead to a worse prognosis among Egyptians with chronic liver disease.

Current situation of viral hepatitis in Egypt

“…Before 2008, a commonly reported risk factor of HCV transmission in Egypt was related to the iatrogenic transmission at health care facilities. Indeed, factors such as old age, rural residence, unsafe injection practices, a history of surgery, dental procedures, hospitalization, blood transfusion, and parenteral antischistosomal therapy were significantly associated with HCV transmission in several studies conducted since 2008 137–141 . These observations supported the notion that health‐care exposures act as driving factors of HCV transmission in Egypt (Figure 2b).…”

“…The prevalence of HCV was 8.7%–40.3% 49,139–143 before the national HCV treatment was implemented (Figure 2c). Although a lower rate of HCV prevalence (4.6%) was recently reported in a large‐scale national study conducted during 2018–2019, 15 a higher rate of HCV prevalence (14.5%–25.9%) was reported by past studies conducted between 2015 and 2017 137,139,140 . The sharp decline in the rate of HCV prevalence reported by Waked et al 15 may be explained by the fact that the majority (66.3%) of the included patients were aged under 45.…”

“…In a national probability‐based study 93 conducted in 2008, the incidence rate of HCV was 6.9/1000 PY. More recently (2015–2017), a higher HCV incidence (20.9/1000 PY) rate was reported among the residents of a village situated in the Lower Egypt area 137 (Figure 2a). This ongoing HCV transmission may be explained by the suboptimal sterilization conditions in some health‐care facilities and hair dressing saloons as well as injection drug use.…”

Viral Interference of Hepatitis C and E Virus Replication in Novel Experimental Co-Infection Systems

“…Some studies investigated HEV seropositivity in HCV-RNA positive patients with mixed results. A higher HEV seropositivity compared to the control group was reported in one study [45] with another confirming these findings in a mixed cohort of chronic HBV and HCV patients [46], while a third did not find any difference in HEV seropositivity between chronic HCV patients and an aged-matched control group [47]. HCV-IgG was enhanced in HEV-IgG positive persons from the 15,000 US NHANES III study population [48], while an Iranian study of 324 hemodialysis patients did not find a link between HCV and HEV seropositivity [49], as did a study analyzing almost 900 HIV-I infected Spanish patients [50].…”

Hepatitis C Viral Infection Among Beta-Thalassemia Patients: A Study From the Centre for Excellence in Thalassemia and Other Blood Disorders

“…An assessment of HCV incidences in America between 2013 and 2016 revealed a 1.7% prevalence [16]. HCV prevalence among the Egyptian population was noted to be above 2% with people with HEV co-infection and advanced liver disease showing quick progression to liver failure and HCC [17].…”