January 6, 2014

Egypt battling hepatitis C epidemic

January 06, 2014

By Leyla Doss/Cairo

After being unemployed for three years, 26-year-old Emad Hassan was offered a job at a local bank on the condition that he take a blood test. It was then that he discovered that he had been infected with the hepatitis C virus (HCV), which can cause liver disease and eventually hepatocellular carcinoma - better known as liver cancer.

The bank consequently withdrew its offer, and Hassan fell victim to the social stigma associated with hepatitis C and other chronic diseases.

In fact, Egypt has the highest prevalence of HCV in the world with 10-14% (8mn to 10mn  people) infected with HCV, and an approximate 1.5mn in need of treatment. Of these, Gamal Esmat, a professor of liver disease in Cairo, notes that the vast majority are in the Nile Delta region.

HCV’s high prevalence in Egypt is in part due to a mass state campaign in the 1960s and 1970s to treat schistosomiasis using improperly sterilised glass syringes and needles.

But a new treatment for HCV could radically change the situation. In collaboration with the ministry of health and other global organisations, the National Hepatology and Tropical Medicine Research Institute (NHTMRI) plans to introduce a new HCV treatment in 2014.

Unlike previous treatments - antiviral drugs that treat HCV by boosting the immune system - the new treatment cures the virus within 12 weeks at a 97% effectiveness rate and with no side effects.

Known as “direct acting antiviral agents,” the new HCV treatment combats the disease by targeting the infected liver cells and destroying the virus’ replication machinery.

Raymond Schinazi, an American research scientist of Italian-Egyptian descent at Atlanta’s Emory University, was the founder of Pharmasset Inc., the company that originally developed the drug. Schinazi’s team of researchers worked for over six years, finding what they consider to be the cure: the PSI-7977 molecule, now named “sofosbuvir,” which the US Food and Drug Administration (FDA) approved on December 8.

Born and raised in Alexandria, Schinazi and his family left Egypt during the large-scale Jewish exodus that took place in the 1950s and 1960s. Schinazi says he still has a close relationship with Egypt and hopes his collaborative research will eventually help cure those infected in his country of birth.

“When I first heard of HCV, I thought to myself: This is my next target,” he says. “My dream was to one day find a cure for it and help my mother country,” says Schinazi, who sold his company and the drug patent to the US-based Gilead Sciences for $11.4bn.

There are currently over six drug companies competing for the production of a HCV cure. But unlike the other drugs in the market, sofosbuvir is also pan-genotypic, which means that it can be used to treat infected people with all genotypes worldwide - including genotype 4, which is most common in Egypt.

Dubbed the “silent epidemic”, hepatitis C has infected approximately 170mn people worldwide and has caused about 350,000 deaths per year from HCV-related diseases.

“Our aim is to provide a treatment for HCV which is safe, effective and with minimal side effects,” says Manal al-Sayed, professor of paediatrics at Ain Shams University and a member of the National Committee for the Control of Viral Hepatitis. “Our challenge will be to have it at affordable prices for all,” she adds.

With prospects of the cure costing as much as $100,000 in the US, many are concerned it would be unaffordable for most Egyptians. Egyptian authorities, doctors, ministry of health members and others are currently negotiating with major pharmaceutical companies producing this and other treatments to reduce costs.

Nevertheless, Egyptian authorities and doctors remain hopeful of bringing HCV treatment to Egypt at 5% of the global price, with the rest subsidized by government authorities.

Hepatitis C is blood-borne, and symptoms are often not visible until 20 years after infection. It can range in severity from a mild illness lasting for a few weeks to a serious, lifelong condition that can lead to cirrhosis of the liver or liver cancer.

Despite treatment and the likelihood of a total cure looking promising in the near future, authorities and researchers admit that more attention should be focused on preventing the infection stage of hepatitis C.

Dina Iskander, a researcher for the Right to Health Programme, applauds the prospects for new treatment, but believes that more attention and expenditure should be directed at the inefficiency of the Egyptian health care system.

According to the US Centers for Disease Control and Prevention (CDC), almost 20% of the Health Ministry’s budget has been allocated to care and treatment and just 1% toward infection control.

In Egypt, there are approximately 165,000 new cases of infection each year, and a staggering 70% of them are related to the health care system. Equipment is often not sterilized according to acceptable standards, and infection is very often transmitted through improperly screened blood transfusions of infected patients.

Other modes of infection include the sharing of unsterilized needles and unsterilized tools for pedicures, manicures and tattoos. In rare cases, HCV can also be transmitted from mother to fetus or through sexual intercourse.

There are, therefore, plans to implement a comprehensive national registry system and screening programs for the disease, al-Sayed says. Over the past six years, there have also been extensive campaigns to raise awareness about infection and treat large numbers of patients for free.

The World Health Organisation says Egypt is one of only two developing countries that provide free universal treatment for HCV. With over 23 centres in Egypt developed over the past six years for treating patients, approximately 300,000 infected individuals have received free care.

Al-Sayed hopes eventually to get more assistance for training and research in the field in order to produce new safe and effective products in Egypt. “This would make it markedly cheaper and easily accessible for all,” she says. “It would be a huge turning point in our history.”- Worldcrunch/Mada Masr

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