Highlights
- •DAAs are effective as treatment for HCV infection.
- •All stages of fibrosis can be treated effectively.
- •All countries are embarking on a global effort to eliminate HCV.
Background and Aims
The introduction of direct-acting antivirals for hepatitis C virus (HCV) in Egypt
led to massive treatment uptake, with Egypt’s national HCV treatment program becoming
the largest in the world. The aim of this paper is to present the Egyptian experience
in planning and prioritizing mass treatment for patients with HCV, highlighting the
difficulties and limitations of the program, as a guide for other countries of similarly
limited resources.
Methods
Baseline data of 337,042 patients, treated between October 2014 to March 2016 in specialized
viral hepatitis treatment centers, were grouped into three equal time intervals of
six months each. Patients were treated with different combinations of direct-acting
antivirals, with or without ribavirin and pegylated interferon. Baseline data, percentage
of patients with known outcome, and sustained virological response at week 12 (SVR12)
were analyzed for the three cohorts. The outcomes of 94,258 patients treated in the
subsequent two months are also included.
Results
For cohort-1, treatment was prioritized for patients with advanced fibrosis (F3-F4
fibrosis, liver stiffness ≥9.5 kPa, or Fibrosis-4 ≥3.25). Starting cohort-2, all stages
of fibrosis were included (F0-F4). The prioritization strategy in the initial phase
caused delays in enrollment and massive backlogs. Cohort-1 patients were significantly
older, and more had advanced fibrosis compared to subsequent cohorts. The percentage
of patients with known SVR12 results were low initially, and increased with each cohort,
as several methods to capture patient results were adopted. Sofosbuvir-ribavirin therapy
for 24 weeks had the lowest SVR12 rate (82.7%); while other therapies were associated
with SVR12 rates between 94% and 98%.
Conclusion
Prioritization based on fibrosis stage was not effective and enrollment increased
greatly only after including all stages of fibrosis. The availability of generic drugs
reduced costs, and helped massively increase uptake of the program. Post-treatment
follow-up was initially very low, and although this has increased, further improvement
is still needed.
Lay summary
We are presenting the largest national program for HCV treatment in the world. We
clearly demonstrate that hepatitis C can be cured efficiently in large scale real-life
programs. This is a clear statement that global HCV eradication is foreseeable, providing
a model for other countries with limited resources and prevalent HCV. Moreover, the
availability of generic products has influenced the success of this program.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 06, 2017
Accepted:
November 20,
2017
Received in revised form:
November 16,
2017
Received:
April 16,
2017
See Editorial, pages 638–639Identification
Copyright
© 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
