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 he had been infected with the Hepatitis C virus (HCV) — a virus that may cause liver disease and eventually hepatocellular carcinoma, better known as liver cancer.
The bank consequently withdrew their offer, and Hassan fell victim to the social stigma associated with Hepatitis C and other chronic diseases.
A new treatment for HCV may radically change the situation, however. In collaboration with the Ministry of Health, the National Hepatology and Tropical Medicine Research Institute (NHTMRI) is aiming to bring in a new treatment for HCV in 2014. The campaign is also taking place in collaboration with the World Health Organization (WHO), Médecins Sans Frontières (MSF), the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) and many prominent individuals.
Unlike previous treatments — antiviral drugs called interferon-alpha and ribavirin which treat HCV by boosting the immune system — the newly tested treatment cures the virus within 12 weeks at a 97 percent effectiveness rate and with no side effects. Known as “direct acting antiviral agents,” the new HCV drug treatments combat 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 Emory University in Atlanta, was the founder of Pharmasset Inc., the company that originally developed the drug. Schinazi’s dedicated team of researchers worked for over six years, finding what they consider to be the cure to the Hepatitis C virus: the PSI-7977 molecule, now named “sofosbuvir,” which was approved by the US-based Food and Drug Association (FDA) on December 8 of this year.
Statistics from the WHO state that Egypt has the highest prevalence of HCV in the world with 10-14 percent – 8 to 10 million – infected with HCV and an approximate 1.5 million in need of treatment. Of these, Gamal Esmat, professor of liver disease at Cairo notes, 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, also known as bilharzia, using improperly sterilized glass syringes and needles.
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 continues to share 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.”
There are currently over six drug companies competing for the production of a cure for HCV.
Unlike the other drugs in the market competing for HCV treatment, sofosbuvir is also pan-genotypic, which means that it can be used to treat infected persons with all genotypes worldwide, including genotype 4, which is most common in Egypt.
Schinazi sold his company, Pharmasset, along with the patent to the molecule for HCV treatment, to Gilead Sciences, a US pharmaceuticals company, for US$11.4 billion.
Esmat at Cairo University believes that if prices can be reduced dramatically, the new treatment could be revolutionary in Egypt.
Dubbed the “silent epidemic,” Hepatitis C has infected approximately 170 million people worldwide and has caused approximately 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 Pediatrics 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, members of the Ministry of Health and members of the NHTMRI are currently negotiating with the drug companies producing this and other treatments to reduce costs in order to bring it to Egypt at affordable prices.
Nevertheless, Egyptian authorities and doctors remain hopeful due to the highly competitive market and previous experiences, of bringing HCV treatment to Egypt at 5 percent of the global price, with the rest subsidized by government authorities.
Hepatitis C is blood-borne and symptoms are often not visible for over 20 years. 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 Program, applauds the prospects for new treatment, but believes that more attention and expenditure should be directed at the inefficiency of the Egyptian healthcare system
According to the US-based United States Centers for Disease Control and Prevention (CDC), almost 20 percent of the Health Ministry’s budget has been allocated to care and treatment, compared to a one percent expenditure on infection control.
In Egypt, there are approximately 165,000 new cases of infection each year, out of which a staggering 70 percent are related to the healthcare 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 for drug use and unsterilized tools at barbers or for pedicures, manicures and tattoos. In more rare cases, HCV can also be transmitted from mother to foetus or through sexual intercourse.
There are, therefore, plans to have a comprehensive national registry system and screening programs for the disease, according to Sayed.
Over the past six years, there have been extensive campaigns to raise awareness on modes on infection and treat large numbers of patients for free.
WHO says that Egypt is one of only two developing countries that provide free universal healthcare for HCV. With over 23 centers in Egypt developed over the past six years for the treatment of Hepatitis C, approximately 300,000 infected individuals have been treated free of charge.
While Egyptian sufferers await a cure, hopes for the near future remain high.
Sayed hopes to eventually get more assistance for training and research in the field in order to produce the 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.”