Hepatitis c In Egypt 2016

1. Hepatitis C In Egypt 2016
Hossam GHONEIM, MD

3. SUDAN
EGYPT
Upper Egypt
19.4%
(95% CI: 17.2-21.6)
Middle Egypt
26.5%
(95% CI: 23.7-29.4)
Alexandria 5.9%
(95% CI: 4.2-7.7)
Lower Egypt
28.4%
(95% CI: 27.1-
29.2)
Cairo
8.2% (95% CI: 6.7-9.8)
L
I
B
Y
A
Red
Sea

4. 1a, 1b
2a, 2b, 2c,
3a
41a, 1b
2a, 2b,
3a
1a, 1b,
2b, 3a
4
5a
1b,
3a
1b,
6
2a 1b
1b,
3a
3b
Fang JWS et al. Clin Liver Dis. 1997;1:493-514
HCV InfectionWorldwide
Genotype Distribution

5. How to diagnose HCV

6. HCV antibodies +ve
Clinical examination
Laboratory investigation
Ultrasonographic examination
Hepatic
decompensation
Liver
cirrhosis
Separate guidelines
Medical problems
Which interfere with
antiviral treatment
Double etiology
1.Autoimmune
2.NASH
3.HBsAg +ve
4.Active Schistoma
Candidate for
Antiviral treatment
Treat
individually
supportive
treatment

7. Natural history

8. Who to treat

9. Candidate for antiviral therapy
ALT&AST results over
6 months
Elevation of ALT&AST
Persistent normal
Liver biopsy
Chronic active hepatitis Cirrhosis
-ve , search for other cause
recheck PCR every 24 weeks
+ VE
- VE
Repeat after 1 month
HVC (PCR) QUALITITIVE
Compensated or Decompensated
Verify ALT is
persistently
normal/ 2 mths
for 6 mths.
Every 6 months
follow-up by liver
tests only and NOT
PCR as long as ALT
is normal.
No need for biopsy
as long as ALT is
normal.

10. How to treat

11. Classic regimen
1 year

12. NEW
• Sofosbuvir
• Simprevir
• Ledisprevir
• Others to come

14. New/old regimen
six months

15. INF free
Regimen 1 .. Six months

16. Regimen 2 .. Three months

17. Regimen 3 .. One month

18. To come
• Merck Receives FDA Approval of ZEPATIER™
(elbasvir and grazoprevir) for the Treatment of
Chronic Hepatitis C Virus Genotype 1 or 4
Infection in Adults Following Priority Review
• ZEPATIER Achieves High Cure Rates (SVR12) in
Broad Range of Patients with Chronic Hepatitis C
Infection, Including Those with Compensated
Cirrhosis, Renal Impairment of Any Degree and
HIV-1/HCV Co-infection
January 28, 2016: 07:01 PM ET

19. Cost