Publications by authors named "Gamal Esmat"

204 Publications

Derivation of "Egyptian varices prediction (EVP) index": A novel noninvasive index for diagnosing esophageal varices in HCV Patients.

J Adv Res 2022 01 24;35:87-97. Epub 2021 Feb 24.

Systems and Information Department, Engineering Research Division, National Research Centre, Giza, Egypt.

Introduction: Esophageal Varices (EVs) is one of the major dangerous complications of liver fibrosis. Upper Gastrointestinal (UGI) Endoscopy is necessary for its diagnosis. Repeated examinations for EVs screening severely burden endoscopic units in terms of cost and other side implications; moreover, the lack of public health resources in rural areas and primary hospitals should be considered, particularly in developing countries. So, an accurate noninvasive marker for EV is highly needed for liver disease patients.

Objectives: This study sought to evaluate the values of several indices to determine how adequate are they in predicting EV and build a novel accurate prediction index.

Methods: Five thousand and thirteen patients were enrolled. The laboratory tests, abdominal ultrasonography, liver stiffness measurement using Fibro-scan, and UGI endoscopy were performed. Ten common indices: Fib-4 score, AST-to-platelet ratio index, Fibrosis index, AST/ALT ratio Varices Prediction Rule, Baveno VI, APRI-Fib4 Combo, King score, "Model for End-Stage Liver Disease", and Lok Score were calculated. The significant predictors for EVs were identified by using "P-value Correlation-based Filter Selection" method, where a novel Egyptian Varices Prediction (EVP) index was developed using binary logistic regression. The diagnostic performance was evaluated by some parameters and the Area Under Curve (AUC).

Results: EVP Index was correlated to EVs at 0.5; it achieved higher performance (AUC 0.788, accuracy 73.3%, and sensitivity 78%) than the other indices at a cutoff point of 0.423.

Conclusion: EVP Index was a good noninvasive predictor. It had an acceptable performance for diagnosing EVs and it was only required regular laboratory tests and imaging data. It can provide a tool for classifying or arranging the patients according to the degree pre-emptive for selective endoscopy and the degree of severity. Also, it will enable clinicians to concentrate on one marker instead of a wide set of parameters.
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http://dx.doi.org/10.1016/j.jare.2021.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721354PMC
January 2022

HIV-related stigma and discrimination by healthcare workers in Egypt.

Trans R Soc Trop Med Hyg 2022 Jan 6. Epub 2022 Jan 6.

Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: HIV-related stigma and discrimination (SAD) have imposed serious adverse health consequences on people living with HIV (PLHIV), including limited access to medical care and delayed diagnosis, which in turn limits the prevention and control of the disease. This study was conducted to explore the stigmatizing attitudes and behaviors of healthcare workers (HCWs) towards HIV patients and PLHIV.

Methods: A cross-sectional study targeted HCWs who attended the United Conference of Hepatogastroenterology and Infectious Diseases that was held on 25-28 September 2019 in Cairo governorate. A self-administrated questionnaire was completed by 359 HCWs.

Results: The majority of HCWs reported some discriminatory practices when rendering care to HIV patients, with nurses showing the highest significant number of discriminatory practices. A considerable proportion of HCWs reported witnessing HIV-related SAD at their health facilities.

Conclusions: HIV-related SAD was prevalent among HCWs. Hence, HIV-related training relevant to the needs of different groups of HCWs is recommended. Provision of infection control supplies to protect against occupational exposure is also needed. The setting and enforcement of anti-stigma policies and guidelines in various healthcare settings are crucial.
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http://dx.doi.org/10.1093/trstmh/trab188DOI Listing
January 2022

The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?

J Hepatol 2021 Dec 8. Epub 2021 Dec 8.

Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent, yet largely underappreciated liver condition which is closely associated with obesity and metabolic disease. Despite affecting an estimated 1 in 4 adults globally, NAFLD is largely absent on national and global health agendas.

Methods: We collected data from 102 countries, accounting for 86% of the world population, on NAFLD policies, guidelines, civil society engagement, clinical management, and epidemiologic data. A preparedness index was developed by coding questions into 6 domains (policies, guidelines, civil awareness, epidemiology and data, NAFLD detection, and NAFLD care management) and categorising the responses as high, medium, and low; a multiple correspondence analysis was then applied.

Results: The highest scoring countries were India (42.7) and the United Kingdom (40.0), with 32 countries (31%) scoring zero out of 100. For 5 of the domains a minority of countries were categorised as high-level while the majority were categorised as low-level. No country had a national or sub-national strategy for NAFLD and <2% of the different strategies for related conditions included any mention of NAFLD. National NAFLD clinical guidelines were present in only 32 countries.

Conclusions: Although NAFLD is a pressing public health problem, no country was found to be well prepared to address it. There is a pressing need for strategies to address NAFLD at national and global levels.

Lay Summary: Around a third of the countries scored a zero on the NAFLD policy preparedness index, with no country scoring over 50/100. Although NAFLD is a pressing public health problem, a comprehensive public health response is lacking in all 102 countries. Policies and strategies to address NAFLD at the national and global levels are urgently needed.
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http://dx.doi.org/10.1016/j.jhep.2021.10.025DOI Listing
December 2021

Current status of hepatitis C virus among people living with human immunodeficiency virus in Egypt.

Trans R Soc Trop Med Hyg 2021 Nov 24. Epub 2021 Nov 24.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: Human immunodeficiency virus (HIV)-hepatitis C virus (HCV) co-infection is increasing due to their similar routes of transmission. Co-infection poses a big challenge. Information on the prevalence of HCV infection in Egyptian HIV individuals is scarce.

Methods: A cross-sectional study was conducted on 1004 HIV individuals who were recruited from July 2018 to March 2019. Blood samples obtained from HIV individuals were subsequently screened for HCV antibodies using the Murex anti-HCV (version 4) enzyme-linked immunosorbent assay test. HCV RNA was performed only on anti-HCV antibody-positive samples. Logistic regression was used to identify factors associated with HCV seroprevalence using SPSS (IBM, Armonk, NY, USA).

Results: Among 1004 participants, 349 exhibited a positive result for anti-HCV antibodies (34.8% [95% confidence interval 31.81 to 37.8]). The most commonly self-reported risk factor of HIV infection by the co-infected participants was intravenous drug use (IDU) (303/349 [86.8%]). In multinomial analysis, risk factors identified as statistically associated with HCV seroprevalence include IDU, history of surgical operations and dental procedures and HIV viral load (p<0.001, 0.032, <0.001 and 0.006, respectively). Under combination antiretroviral therapy (cART), the proportion of HIV mono-infected individuals with an undetectable HIV viral load was significantly higher than those with co-infection (p<0.0007). We also found that HIV-HCV co-infected participants exhibited significantly higher CD4+ cell counts than those with HIV mono-infection (p=0.04).

Conclusions: The prevalence of HIV-HCV co-infection is higher in Egypt compared with other countries in Africa. It is essential to screen all HIV-infected patients for HCV infection for early identification, counselling and initiation of anti-HCV treatment.
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http://dx.doi.org/10.1093/trstmh/trab176DOI Listing
November 2021

Eliminating hepatitis C from countries with high prevalence: When infrastructure comes first.

Indian J Med Res 2021 07;154(1):1-3

Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt.

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http://dx.doi.org/10.4103/ijmr.ijmr_1911_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8715699PMC
July 2021

Management of liver disease patients in different clinical situations during COVID-19 pandemic.

Egypt Liver J 2021 26;11(1):21. Epub 2021 Mar 26.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Chronic liver diseases are common worldwide, especially in developing countries. The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/(COVID-19) leads to the infection of many patients with underlying chronic liver diseases. As a relatively new disease, management of COVID-19, in the context of chronic liver disease, is mainly based on the experience of the treating physician and the available data. In this review, we summarize the available evidence about the management of liver disease patients, in the context of COVID-19 infection, which can increase the severity of viral hepatitis B. Also, its clearance in HBV patients is delayed. A sixfold increased severity of COVID-19 was reported in obese patients with metabolic associated fatty liver disease (MAFDL). In patients with autoimmune liver disease (AILD), it is not recommended to change their immunosuppressive therapy (as long as they are not infected with COVID-19), in order to avoid a flare of liver disease. However, immunosuppressant drugs should be modified, in the case of infection with COVID-19. To date, no data suggest an increased risk or severity in metabolic liver diseases, such as hemochromatosis, Wilson's disease, or alpha-1 antitrypsin deficiency. Patients with liver cirrhosis should be carefully managed with minimum exposure to healthcare facilities. Basic investigations for follow-up can be scheduled at wider intervals; if patients need admission, this should be in COVID-19-clean areas. Patients with hepatocellular carcinomas may have a poor prognosis according to preliminary reports from China. The course of COVID-19 in liver transplant recipients on immunosuppression seems to have a benign course, based on few reports in children and adults. The hepatotoxicity of COVID-19 drugs ranges from mild liver enzyme elevation to a flare of underlying liver diseases. Therefore, the decision should be customized. Telemedicine can minimize the exposure of healthcare workers and patients to infection with COVID-19 and decrease the consumption of personal protective equipment.
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http://dx.doi.org/10.1186/s43066-021-00091-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994958PMC
March 2021

Real-life experience of treating HCV co-infection among HIV-infected population in Egypt: single-center experience.

Expert Rev Anti Infect Ther 2021 Nov 25:1-7. Epub 2021 Nov 25.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Giza, Egypt.

Background: Liver disease has emerged as a leading cause of death among PLHIV coinfected with HCV.

Methods: A retrospective study involving all HCV viremic patients coinfected with HIV who presented to HCV/HIV multidisciplinary clinics located at Embaba fever hospital. Patients were assigned to receive DAAs according to the national treatment guidelines. The primary endpoint was SVR12.

Results: Of the 519 patients enrolled, 38.73% LTFU; either not initiated (n = 170) or did not complete the treatment (n = 31). The main identified reasons behind LTFU were schedule conflict (19%) or hospitalization (13%). Among 318 patients who completed their DAAs course, nine patients had a relapse after the end of treatment and 97% had attained SVR12. There were significant differences among different virological response groups in baseline factors including smoking (p = 0.005), history of dental procedure (p = 0.007), CD4 count (p = 0.007), and HIV viral load (p = <0.001). Among responders (n = 309), there was a significant reduction of baseline hemoglobin and significant improvement of baseline platelets (p = 0.005) at on-treatment week 8. Baseline necro-inflammatory markers showed significant improvement across follow-up time points (p < 0.001).

Conclusions: DAAs are an effective and safe choice to treat HCV in PLHIV. Social stigma could be a major cause for lacking adherence to follow-up visits. ALT: Alanine Aminotransferase; ARV: Antiretroviral treatment; AST: Aspartate Aminotransferase; DAAs: Direct acting antivirals; ARVs: antiretroviral therapy; EMR: Eastern Mediterranean region; HCV: Hepatitis C virus; kPa: Kilopascal; LTFU: Patient lost to follow up; NCCVH: The National Committee for Control of Viral Hepatitis; PWID: People who inject drugs; SVR: Sustained virological response;UNAIDS: The Joint United Nations Programme on HIV/AIDS.
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http://dx.doi.org/10.1080/14787210.2022.2004117DOI Listing
November 2021

The evolving challenges confronting adults living with HIV in three North African countries during the COVID-19 crisis: a survey-based study.

Trans R Soc Trop Med Hyg 2021 Oct 21. Epub 2021 Oct 21.

Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo 11212, Egypt.

Background: Coronavirus disease 2019 (COVID-19) has resulted in a huge burden on healthcare systems, especially on programs for chronic illnesses such as HIV. We aimed to assess the challenges confronting adult people living with HIV (PLHIV) in three countries in North Africa during the COVID-19 crisis and their awareness of COVID-19 non-pharmaceutical preventive measures.

Methods: This online survey included PLHIV aged ≥18 y from three countries in North Africa recruited by a snowball sampling technique, who were asked to complete a modified questionnaire originally developed by the University of Antwerp in Belgium, which was then disseminated through social media tools to assess the study outcomes.

Results: Out of 369 respondents, 260 (70.5%) were males and 237 (64.2%) were aged 18-39 y. Adherence to COVID-19 preventive measures, wearing facemasks (308 [83.2%]), applying hand-sanitizers (299 [80.8%]) and following cough etiquette (261 [70.5%]), were predominantly reported. Only 48 (13%) were vaccinated against influenza. One hundred and forty-five participants (42%) experienced flu-like symptoms, 29 (20%) were tested for COVID-19, with only one confirmed case identified. Among 344 (93.2%) on antiretroviral therapy (73.8% efavirenz- vs 6.4% dolutegravir-based regimens), 219 (63.7%) attended their scheduled visits, 144 (41.9%) had limited access to care due to lockdown and 29 (8.4%) became less adherent to their antiretroviral therapy. Covariates associated with challenges during access to care were age ≥60 y (OR=6.5; 95% CI 1.8 to 23.2) and receiving second-line HIV treatment such as protease inhibitors (OR=2.7; 95% CI 1.3 to 5.8).

Conclusion: The pandemic adversely affected PLHIV. New innovative strategies should be implemented to ensure the continuity of HIV services.
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http://dx.doi.org/10.1093/trstmh/trab157DOI Listing
October 2021

Evaluation of factors affecting patients' refusal of HCV treatment in a cohort of Egyptian patients.

J Public Health (Oxf) 2021 Oct 14. Epub 2021 Oct 14.

Endemic medicine department, Faculty of Medicine, Cairo University, Cairo 11652, Egypt.

Background: Treatment refusal, defined as active refusal of a patient to receive treatment despite physician recommendations, has not been extensively evaluated before in hepatitis C virus in the era of direct acting antivirals.

Objective: To investigate the reasons for refusal to receive hepatitis C virus treatment in Egypt.

Methods: an observational study conducted between July 2018 and November 2019 in Egypt. Enrollment was done to all patients who refused to get hepatitis C virus treatment during the national screening and treatment campaign. Reasons for their refusal were identified using a questionnaire as an instrument for data collection.

Results: Out of the 220 280 Egyptian hepatitis C virus patients who did not show up to start treatment and were contacted to get therapy, only 84 patients (0.038%) refused to receive treatment. The main reason for their refusal was having concerns about treatment (82.14%) and their main concern was the fear of adverse events (85.5%). Other causes of refusal were non-satisfactory experience at treatment centers (13.09%) and patients preferred to receive complementary and alternative medicines (4.7%). Most patients (65.4%) trusted the efficacy of directly acting antivirals for hepatitis C. None of the study participants was found to suffer from any psychiatric morbidity and the average score of the GHQ-12 was 10.7155.

Conclusion: Proper health education and awareness regarding hepatitis C virus treatment safety and efficacy is needed to increase treatment acceptance rates.
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http://dx.doi.org/10.1093/pubmed/fdab363DOI Listing
October 2021

Predictors of severity and development of critical illness of Egyptian COVID-19 patients: A multicenter study.

PLoS One 2021 23;16(9):e0256203. Epub 2021 Sep 23.

Gastroenterology & Infectious Diseases Department, Ahmed Maher Teaching Hospital, Cairo, Egypt.

Objectives: We conducted the present multicenter, retrospective study to assess the epidemiological, clinical, laboratory, and radiological characteristics associated with critical illness among patients with COVID-19 from Egypt.

Methods: The present study was a multicenter, retrospective study that retrieved the data of all Egyptian cases with confirmed COVID-19 admitted to hospitals affiliated to the General Organization for Teaching Hospitals and Institutes (GOTHI) through the period from March to July 2020. The diagnosis of COVID-19 was based on a positive reverse transcription-polymerase chain reaction (RT-PCR) laboratory test.

Results: This retrospective study included 2724 COVID-19 patients, of whom 423 (15.52%) were critically ill. Approximately 45.86% of the critical group aged above 60 years, compared to 39.59% in the non-critical group (p = 0.016). Multivariate analysis showed that many factors were predictors of critically illness, including age >60 years (OR = 1.30, 95% CI [1.05, 1.61], p = 0.014), low oxygen saturation (OR = 0.93, 95% CI [0.91, 0.95], p<0.001), low Glasgow coma scale (OR = 0.75, 95% CI [0.67, 0.84], p<0.001), diabetes (OR = 1.62, 95% CI [1.26, 2.08], p<0.001), cancer (OR = 2.47, 95% CI [1.41, 4.35], p = 0.002), and serum ferritin (OR = 1.004, 95% CI [1.0003, 1.008], p = 0.031).

Conclusion: In the present report, we demonstrated that many factors are associated with COVID-19 critical illness, including older age groups, fatigue, elevated temperature, increased pulse, lower oxygen saturation, the preexistence of diabetes, malignancies, cardiovascular disease, renal diseases, and pulmonary disease. Moreover, elevated serum levels of ALT, AST, and ferritin are associated with worse outcomes. Further studies are required to identify independent predictors of mortality for patients with COVID-19.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256203PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459940PMC
October 2021

Hepatitis C elimination in Africa: Seizing the moment for hepatitis-C free future.

Arab J Gastroenterol 2021 09 13;22(3):249-251. Epub 2021 Sep 13.

Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt. Electronic address:

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http://dx.doi.org/10.1016/j.ajg.2021.07.002DOI Listing
September 2021

Safety of inhaled ivermectin as a repurposed direct drug for treatment of COVID-19: A preclinical tolerance study.

Int Immunopharmacol 2021 Oct 23;99:108004. Epub 2021 Jul 23.

Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt; Pharmaceutical Factory, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt.

Introduction: SARS-CoV-2 replication in cell cultures has been shown to be inhibited by ivermectin. However, ivermectin's low aqueous solubility and bioavailabilityhinders its application in COVID-19 treatment. Also, it has been suggested that best outcomes for this medication can be achieved via direct administration to the lung.

Objectives: This study aimed at evaluating the safety of a novel ivermectin inhalable formulation in rats as a pre-clinical step.

Methods: Hydroxy propyl-β-cyclodextrin(HP-β-CD) was used to formulate readily soluble ivermectin lyophilized powder. Adult male rats were used to test lung toxicity for ivermectin-HP-β-CD formulations in doses of 0.05, 0.1, 0.2, 0.4 and 0.8 mg/kg for 3 successive days.

Results: The X-ray diffraction for lyophilized ivermectin-HP-β-CD revealed its amorphous structure that increased drug aqueous solubility 127-fold and was rapidly dissolved within 5 s in saline.Pulmonary administration of ivermectin-HP-β-CD in dosesof 0.2, 0.4 and 0.8 mg/kgshowed dose-dependent increase in levels of TNF-α, IL-6, IL-13 and ICAM-1 as well as gene expression of MCP-1, protein expression of PIII-NP and serum levels of SP-D paralleled by reduction in IL-10. Moreover, lungs treated with ivermectin (0.2 mg/kg) revealed mild histopathological alterations, while severe pulmonary damage was seen in rats treated with ivermectin at doses of 0.4 and 0.8 mg/kg. However, ivermectin-HP-β-CD formulation administered in doses of 0.05 and 0.1 mg/kg revealed safety profiles.

Conclusion: The safety of inhaledivermectin-HP-β-CD formulation is dose-dependent. Nevertheless, use of low doses(0.05 and 0.1 mg/kg) could be considered as a possible therapeutic regimen in COVID-19 cases.
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http://dx.doi.org/10.1016/j.intimp.2021.108004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299187PMC
October 2021

HCV/HIV coinfected Egyptian patients: a cross-sectional study of their main characteristics and barriers to HCV treatment initiation.

Trans R Soc Trop Med Hyg 2021 Jul 21. Epub 2021 Jul 21.

Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: This study investigates different barriers preventing a cohort of Egyptian HIV/HCV coinfected patients from accessing HCV treatment, despite being available and free of charge, aiming to improve the long-term outcomes of coinfected patients and decreasing their liver-related morbidity and mortality.

Methods: This study included HIV patients who were referred to Kasr Alainy Viral Hepatitis Center to receive HCV treatment and who had to continue pretreatment assessment in order to receive direct acting antiviral agents free of charge. Patients who did not attend within 90 d were questioned via a telephone interview. Questions addressed sociodemographic status, HIV status and the main barriers to accessing healthcare.

Results: Overall, 474 HIV/HCV coinfected patients were eligible for HCV treatment and 223 (47.1%) patients did not complete work-up for HCV treatment. Fear of community stigma concerning HIV/HCV was the most important barrier to compliance with treatment (73.3%), followed by lack of a supportive work environment and employment opportunities (51.5%), whereas 39.3% stopped follow-up due to the lack of integrated services in the healthcare facility.

Conclusions: Managing HCV in HCV/HIV coinfected patients still represents a major challenge, not only for healthcare providers, but also at a community level, to improve community awareness and manage the major obstacle facing those patients regarding community stigma.
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http://dx.doi.org/10.1093/trstmh/trab106DOI Listing
July 2021

Impact of successful HCV treatment using direct acting antivirals on recurrence of well ablated hepatocellular carcinoma.

Expert Rev Anti Infect Ther 2021 Jul 15:1-8. Epub 2021 Jul 15.

Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: There are many contradictory studies that dealt with hepatocellular carcinoma (HCC) recurrence rate of well ablated hepatitis C virus (HCV) related HCC. We aim to assess the recurrence rate of previously ablated HCC in patients who received direct acting antiviral (DAA) for their HCV.

Research Design And Methods: This is a retrospective data analysis of 523 HCV patients who have a history of successfully ablated HCC and eligible for HCV treatment. Retrieval was done to demographic/clinical data, HCV pretreatment investigations, HCV treatment outcome. Follow up for survival and HCC recurrence was done every 3 months using abdominal ultrasound and alfa-fetoprotein.

Results: Mean age was 53.83 years. Sofosbuvir/daclatasvir/ribavirin was the most used regimen (35.4%) with 438 patients (83.7%) achieved sustained virologic response (SVR). The median duration for surveillance was 159 weeks. Hundred and five patients developed recurrent HCC, with a crude recurrence rate of 20.1%. There was no difference between HCV responders and non-responders in crude recurrence rate (p = 0.94) but HCC developed earlier in non-responders (p = <0.01).

Conclusion: Recurrence of HCC remains a threat in HCV patients even after achieving an SVR. Implementation of long-term surveillance programs is highly recommended.
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http://dx.doi.org/10.1080/14787210.2021.1951230DOI Listing
July 2021

Long-term clinical outcomes in sustained responders with chronic hepatitis C after treatment with direct-acting antivirals.

Eur J Gastroenterol Hepatol 2021 Dec;33(1S Suppl 1):e746-e752

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University.

Objective: Little is known about how the achievement of sustained virological response (SVR) after treatment with direct-antiviral agents (DAAs) affects fibrosis and clinical outcomes in the long term. Our study aimed to evaluate the impact of achieving SVR on long-term changes in fibrosis and clinical outcomes in CHC patients treated with different DAAs-based regimens.

Methods: a prospective, 3-year follow-up study of 113 CHC patients who had achieved SVR after treatment with different DAAs-based regimens between January and June 2015 was conducted. The clinical outcomes of SVR on the biochemical profile, changes in fibrosis, ALBI score and grade and occurrence of liver-related events were analyzed.

Results: Overall, liver function parameters and serum alpha-fetoprotein level showed improvement from baseline to SVR12 and remained steady thereafter. Moreover, the ALBI score showed nonsignificant change at baseline to SVR12 (P = 0.2) but it was significantly better at 3-years follow-up than at SVR12 (P = 0.001). Regarding liver stiffness (LS) by transient elastography, a significant decrease in TE values was observed between baseline to SVR12 (P ≤ 0.0001) as well as between SVR12 to 3-years follow-up (P = 0.0005). Stratified by fibrosis stage, patients with advanced fibrosis and cirrhosis showed a more pronounced and significant improvement of LS during follow-up after SVR compared to patients with less advanced fibrosis stage. During the follow-up period, 3 (5.2%) cirrhotic patients developed liver-related events, including 2 (3.4%) patients with de novo HCC and one (1.7%) patient experienced ascites for the first time.

Conclusion: This 3-year follow-up study provides evidence for the durability of SVR, improvement of liver function parameters and ALBI score and grade in patients with an advanced stage of fibrosis, in particular, and reduction of the clinical events after successful treatment with DAAs.
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http://dx.doi.org/10.1097/MEG.0000000000002240DOI Listing
December 2021

Efficacy of combined Sofosbuvir and Daclatasvir in the treatment of COVID-19 patients with pneumonia: a multicenter Egyptian study.

Expert Rev Anti Infect Ther 2021 Jul 15:1-5. Epub 2021 Jul 15.

Endemic medicine department, Cairo University Hospitals, Cairo, Egypt.

Background: Limited experimental and clinical evidence suggests a potential role for sofosbuvir/daclatasvir in treating COVID19. We aim to evaluate the efficacy of generic sofosbuvir/daclatasvir in treating COVID-19 patients with pneumonia.

Research Design And Methods: This multicenter prospective study involved 174 patients with COVID-19. Patients were randomized into two groups. Group A (96 patients) received sofosbuvir (400 mg)/daclatasvir (60 mg) for 14 days in combination with conventional therapy. Group B (78 patients) received conventional therapy alone. Clinical, laboratory, and radiological data were collected at baseline, after 7, 14, and 28 days of therapy. Primary endpoint was rate of clinical/virological cure.

Results: A lower mortality rate was observed in group (A) (14% vs 21%, P = 0.07). After 1 month of therapy, no differences were found in rates of ICU admission, oxygen therapy, or ventilation. Additionally, a statistically significant shorter duration of hospital stay (9% vs 12%, P < 0.01) and a faster achievement of PCR negativity at day 14 (84% versus 47%, P < 0.01) were noticed in group (A).

Conclusion: Adding sofosbuvir/daclatasvir to conventional therapy of COVID-19 is promising. Their use is associated with shorter hospital stay, faster PCR negativity and may be reduced mortality.
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http://dx.doi.org/10.1080/14787210.2021.1950532DOI Listing
July 2021

Micro-elimination of hepatitis C among people living with HIV in Egypt.

Liver Int 2021 07;41(7):1445-1447

Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt.

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http://dx.doi.org/10.1111/liv.14974DOI Listing
July 2021

Gastrointestinal manifestations of human immunodeficiency virus and coronavirus disease 2019: Understanding the intersecting regions between the two epidemics.

Arab J Gastroenterol 2021 Jun 26;22(2):75-87. Epub 2021 May 26.

Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

In March 2020, the World Health Organization declared coronavirus disease (COVID-19) a pandemic. As of February 2021, there were 107 million COVID-19 cases worldwide. As a comparison, there are approximately 38 million people living with human immunodeficiency virus (PLHIV) worldwide. The coexistence of both epidemics, and the syndemic effect of both viruses could lead to a delirious impact both at individual and community levels. Many intersecting points were found between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, and HIV; among which, gastrointestinal (GI) manifestations are the most notable. GI manifestations represent a common clinical presentation in both HIV and SARS-CoV-2. The emergence of GI symptoms as a result of SARS-CoV-2 infection provides a new dynamic to COVID-19 diagnosis, management, and infection control measures, and adds an additional diagnostic challenge in case of coinfection with HIV. The presence of GI manifestations in PLHIV during the COVID-19 pandemic could be referred to HIV enteropathy, presence of opportunistic infection, adverse effect of antiretrovirals, or coinfection with COVID-19. Thus, it is important to exclude SARS-CoV-2 in patients who present with new-onset GI manifestations, especially in PLHIV, to avoid the risk of disease transmission during endoscopic interventions. Structural similarities between both viruses adds a valuable intersecting point, which has mutual benefits in the management of both viruses. These similarities led to the hypothesis that antiretrovirals such as lopinavir/Rironavir have a role in the management of COVID-19, which was the target of our search strategy using the available evidence. These similarities may also facilitate the development of an efficient HIV vaccine in the future using the advances in COVID-19 vaccine development.
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http://dx.doi.org/10.1016/j.ajg.2021.05.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149211PMC
June 2021

Clinical study evaluating the efficacy of ivermectin in COVID-19 treatment: A randomized controlled study.

J Med Virol 2021 Oct 7;93(10):5833-5838. Epub 2021 Jun 7.

Department of Endemic Medicine, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.

Researchers around the world are working at record speed to find the best ways to treat and prevent coronavirus disease 2019 (COVID-19). This study aimed to evaluate the efficacy of ivermectin for the treatment of hospitalized mild to moderate COVID-19 infected patients. This was a randomized open-label controlled study that included 164 patients with COVID-19. Patients were randomized into two groups where Group 1 (Ivermectin group) included patients who received ivermectin 12 mg once daily for 3 days with standard care and Group 2 (control group) included patients who received standard protocol of treatment alone for 14 days. The main outcomes were mortality, the length of hospital stay, and the need for mechanical ventilation. All patients were followed up for 1 month. Overall, 82 individuals were randomized to receive ivermectin plus standard of care and 82 to receive standard of care alone. Patients in the ivermectin group had a shorter length of hospital stay (8.82 ± 4.94 days) than the control group (10.97 ± 5.28 days), but this was not statistically significant (p = 0.085). Three patients (3.7%) in each group required mechanical ventilation (p = 1.00). The death rate was three patients in the ivermectin group (3.7%) versus four patients (4.9%) in the control group without any significant difference between the two groups (p = 1.00). Although there was no statistically significant difference in any endpoints by ivermectin doses (12 mg/day for 3 days); there was an observed trend to reducing hospital stay in the ivermectin-treated group.
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http://dx.doi.org/10.1002/jmv.27122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242425PMC
October 2021

Anticancer activity of milk fat rich in conjugated linoleic acid against Ehrlich ascites carcinoma cells in female Swiss albino mice.

Vet World 2021 Mar 20;14(3):696-708. Epub 2021 Mar 20.

Department of Clinical and Chemical Pathology, National Cancer Institute, Cairo University, Giza, Egypt.

Background And Aim: The major conjugated linoleic acid (CLA) isomers have anticancer effect, especially breast cancer cells, inhibits cell growth and induces cell death. Also, CLA has several health benefits , including antiatherogenesis, antiobesity, and modulation of immune function. The present study aimed to assess the safety and anticancer effects of milk fat CLA against Ehrlich ascites carcinoma (EAC) in female Swiss albino mice. This was based on acute toxicity study, detection of the tumor growth, life span of EAC bearing hosts, and simultaneous alterations in the hematological, biochemical, and histopathological profiles.

Materials And Methods: One hundred and fifty adult female mice were equally divided into five groups. Groups (1-2) were normal controls, and Groups (3-5) were tumor transplanted mice (TTM) inoculated intraperitoneally with EAC cells (2×10/0.2 mL). Group (3) was (TTM positive control). Group (4) TTM fed orally on balanced diet supplemented with milk fat CLA (40 mg CLA/kg body weight). Group (5) TTM fed orally on balanced diet supplemented with the same level of CLA 28 days before tumor cells inoculation. Blood samples and specimens from liver and kidney were collected from each group. The effect of milk fat CLA on the growth of tumor, life span of TTM, and simultaneous alterations in the hematological, biochemical, and histopathological profiles were examined.

Results: For CLA treated TTM, significant decrease in tumor weight, ascetic volume, viable Ehrlich cells accompanied with increase in life span were observed. Hematological and biochemical profiles reverted to more or less normal levels and histopathology showed minimal effects.

Conclusion: The present study proved the safety and anticancer efficiency of milk fat CLA and provides a scientific basis for its medicinal use as anticancer attributable to the additive or synergistic effects of its isomers.
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http://dx.doi.org/10.14202/vetworld.2021.696-708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076465PMC
March 2021

Pregnancy outcome of anti-HCV direct-acting antivirals: Real-life data from an Egyptian cohort.

Liver Int 2021 07 11;41(7):1494-1497. Epub 2021 May 11.

Department of Pediatrics and Clinical Research Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

We aimed to assess the pregnancy outcome in women with chronic HCV who had negative pregnancy test prior to the anti-HCV course and had unintended pregnancy while on HCV treatment. Hundred patients with a mean age of 30 ± 6.7 y were included and advised to withhold antivirals and continue follow-up in viral hepatitis and obstetrics centres till delivery. All patients received a 12-weeks regimen of anti-HCV [sofosbuvir plus daclatasvir (SOF/DCV): n = 95, SOF/DCV plus ribavirin: n = 3, and paritaprevir/ritonavir/ombitasvir plus ribavirin: n = 2]. Only nine patients completed the full antiviral course against medical advice, and 91 stopped between on-treatment weeks 4 and 8. Eighty-eight patients delivered full-term babies, eight had preterm babies and two had abortions. Of the nine patients who completed the full course of DAAs, seven (77.8%) delivered normal babies, attended their post-treatment week 12 visit, and all (100%) achieved sustained virological response. No major antiviral-related adverse events were reported.
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http://dx.doi.org/10.1111/liv.14913DOI Listing
July 2021

Hepatitis C viral RNA in blood mononuclear cells of patients treated with directly acting antivirals.

Arab J Gastroenterol 2021 Jun 2;22(2):158-163. Epub 2021 Apr 2.

Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background And Study Aims: Occult hepatitis C viral infection (OCI) may have serious complications, such as relapse, ongoing histological impairment, hepatic decompensation, hepatocellular carcinoma, and the possible risk of transmission. This study was conducted to assess the occurrence and prevalence of secondary OCI in patients with chronic hepatitis C viral infection (HCV) who received a complete course of directly acting antivirals (DAAs).

Patients And Methods: Antiviral therapy consisted of sofosbuvir + daclatasvir ± ribavirin for 12 weeks to 90 treatment-naive, compensated, chronic HCV patients. Plasma and peripheral blood mononuclear cells (PBMCs) were tested for HCV RNA viral load by quantitative, reverse transcription, real-time PCR at 8, 12 (Group I, n = 45), and 24 (Group II, n = 45) weeks after treatment initiation.

Results: By week 8, only 2 and 7 patients were positive for HCV RNA in plasma and PBMCs, respectively. No HCV RNA was detected by weeks 12 or 24 in the PBMCs of Groups I and II, respectively. Older age was significantly associated with HCV RNA positivity in plasma and PBMCs (n = 8) at week 8 compared with HCV RNA negativity (n = 82). No other significant differences were observed for any other variables.

Conclusion: The development of secondary OCI among easy-to-treat patients following a full course of DAA treatment doesn't exist, hence, we do not recommend testing the HCV RNA in the PBMCs after complete course of treatment in this patient category. The detection of HCV RNA in PBMCs is recommended as a confirmatory test of cure following a shortened DAA treatment regimen.
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http://dx.doi.org/10.1016/j.ajg.2021.03.001DOI Listing
June 2021

MAFLD considerations as a part of the global hepatitis C elimination effort: an international perspective.

Aliment Pharmacol Ther 2021 05 22;53(10):1080-1089. Epub 2021 Mar 22.

Geneva, Switzerland.

Background: The World Health Organization (WHO) set a goal to eliminate hepatitis C (HCV) infection globally by 2030, with specific targets to reduce new viral hepatitis infections by 80% and reduce related deaths by 65%. However, an overlooked aspect that may hinder these efforts is the impact other liver diseases could have by continuing to drive liver disease progression and offset the beneficial impact of DAAs on end-stage liver disease and hepatocellular carcinoma (HCC). In particular, the decrease in HCV prevalence has been countered by a marked increase in the prevalence of metabolic-associated fatty liver disease (MAFLD).

Aims: To review the potential interaction of HCV and MAFLD.

Methods: We have reviewed the literature relating to an arrange of interaction of HCV, metabolic dysfunction and MAFLD.

Results: In this viewpoint, international experts suggest a holistic and multidisciplinary approach for the management of the growing number of treated HCV patients who achieved SVR, taking into consideration the overlooked impact of MAFLD for reducing morbidity and mortality in people who have had HCV.

Conclusions: This will strengthen and improve the continuum of care cascade for patients with liver disease(s) and holds the potential to alleviate the cost burden of disease; and increase quality of life for patients following DAAs treatment.
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http://dx.doi.org/10.1111/apt.16346DOI Listing
May 2021

COVID-19 crisis effect on HIV service delivery in Egypt: Hard times or blessings in disguise?

South Afr J HIV Med 2020 9;21(1):1170. Epub 2020 Dec 9.

Endemic Medicine Department, Kasr Alainy School of Medicine, Cairo University Hospitals, Cairo, Egypt.

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http://dx.doi.org/10.4102/sajhivmed.v21i1.1170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7736654PMC
December 2020

WGO Guidance for the Care of Patients With COVID-19 and Liver Disease.

J Clin Gastroenterol 2021 01;55(1):1-11

Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as "bystander hepatitis," myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19-such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.
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http://dx.doi.org/10.1097/MCG.0000000000001459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713641PMC
January 2021

The interrelation between lipid profile in chronic HCV patients and their response to antiviral agents.

Expert Rev Gastroenterol Hepatol 2021 Jan 2;15(1):103-110. Epub 2020 Nov 2.

Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University , Cairo, Egypt.

Objectives: This study aims to assess the changes of lipid profile in chronic HCV patients; before, during, and after treatment with DAAs and their association with treatment response.

Methods: 301 chronic HCV patients who received SOF-based therapy were included. Serum lipid profile was assessed at different check points; baseline, 6 weeks on treatment, end of treatment (EOT) and 12 weeks after EOT; and compared between SVR and non-SVR groups.

Results: SVR group had significantly higher baseline lipid parameters compared to non-SVR group with significant increase in lipid parameters at different time points apart from HDL-C. Non-SVR group showed non-significant change in lipid parameters apart from LDL-C. On week6 on treatment, cholesterol level > 125 mg/dl was 92.8% sensitive, 97.3% specific with 95.5% NPV, and AUC of 0.989 in prediction of SVR. Similarly, LDL > 57 mg/dl was 83.7% sensitive, 100% specific with 93.3%, NPV and AUC of 0.952. Baseline cholesterol and LDL were significantly associated with SVR.

Conclusion: Higher baseline lipid parameters and their further elevation starting from week 6 on treatment are good predictors of SVR in HCV patients. Successful HCV therapy with DAAs is associated with a significant increase in lipid parameters.
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http://dx.doi.org/10.1080/17474124.2020.1823831DOI Listing
January 2021

Antiretroviral therapy optimisation in the time of COVID-19: Is it really different in North and South Africa?

South Afr J HIV Med 2020 30;21(1):1118. Epub 2020 Jul 30.

Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt.

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http://dx.doi.org/10.4102/sajhivmed.v21i1.1118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433226PMC
July 2020

Renal profile of chronic hepatitis C patients with sofosbuvir-based therapy.

Infection 2020 Dec 20;48(6):913-922. Epub 2020 Aug 20.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.

Purpose: The impact of SOF-based therapy on renal functions is quite controversial in clinical practice. Therefore, we aimed to evaluate the serial changes of renal indices during SOF-based therapy in CHC patients with normal kidney function or mild renal impairment.

Methods: We retrospectively reviewed all CHC patients who received different SOF-based regimens from January 2015 until December 2017, and presented with a baseline eGFR ≥ 30 ml/min/1.73m. Patients who didn't achieve SVR, with missing creatinine or eGFR data, and patients with eGFR less than 30 ml/min/1.73m at baseline were excluded. eGFR was calculated for each time of evaluation using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

Results: A total of 1004 patients were finally included. The mean serum creatinine and eGFR levels varied between 0.84 mg/dl and 106.53 ml/min/1.73m for baseline and 0.87 mg/dl and 104.24 ml/min/1.73m for SVR12, respectively. The maximum increase of creatinine was 3.69 mg/dl and the maximum decrease of eGFR level was 83.30 ml/min/1.73m during treatment. Moreover, 74.4% of treated patients stayed in the same eGFR category, 14.3% progressed to a higher eGFR category, and 11.3% had an improvement eGFR category at EOT and continued to SVR12. Age > 65 years, baseline eGFR, and ribavirin-containing regimens were independent risk factors of eGFR decline during and after SOF-based treatment.

Conclusion: SOF-based therapies seem to be safe in CHC patients with baseline normal or slightly impaired renal function.
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http://dx.doi.org/10.1007/s15010-020-01505-5DOI Listing
December 2020

Machine Learning Prediction Models for Diagnosing Hepatocellular Carcinoma with HCV-related Chronic Liver Disease.

Comput Methods Programs Biomed 2020 Nov 23;196:105551. Epub 2020 May 23.

Endemic Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address:

Background And Objective: Considered as one of the most recurrent types of liver malignancy, Hepatocellular Carcinoma (HCC) needs to be assessed in a non-invasive way. The objective of the current study is to develop prediction models for Chronic Hepatitis C (CHC)-related HCC using machine learning techniques.

Methods: A dataset, for 4423 CHC patients, was investigated to identify the significant parameters for predicting HCC presence. In this study, several machine learning techniques (Classification and regression tree, alternating decision tree, reduce pruning error tree and linear regression algorithm) were used to build HCC classification models for prediction of HCC presence.

Results: Age, alpha-fetoprotein (AFP), alkaline phosphate (ALP), albumin, and total bilirubin attributes were statistically found to be associated with HCC presence. Several HCC classification models were constructed using several machine learning algorithms. The proposed HCC classification models provide adequate area under the receiver operating characteristic curve (AUROC) and high accuracy of HCC diagnosis. AUROC ranges between 95.5% and 99%, plus overall accuracy between 93.2% and 95.6%.

Conclusion: Models with simplistic factors have the power to predict the existence of HCC with outstanding performance.
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http://dx.doi.org/10.1016/j.cmpb.2020.105551DOI Listing
November 2020

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

Environ Sci Pollut Res Int 2020 Sep 12;27(27):33659-33667. Epub 2020 Jun 12.

Tropical Medicine Department, Faculty of Medicine, Tanta University Hospital, Tanta University, El Geish Street, Tanta, Gharbia Governorate, Egypt.

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.
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http://dx.doi.org/10.1007/s11356-020-09591-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292573PMC
September 2020
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