Hepatitis C, or more precisely HCV genotype 4, is a major health problem in Egypt. Millions of Egyptians are infected. And many will develop deadly diseases like cirrhosis, liver cancer and non-Hodgkin’s lymphoma in the long run. Surprisingly, some 15% to 20% of those infected can clear the virus themselves. The EU-funded project, SPHINX, due to end in March 2014, has set out to find a solution for the Egyptian epidemic. Project coordinator Matthew Albert is director of the immunology department and director of the laboratory of dendritic cell immunobiology at the Institut Pasteur in Paris, France. He talks to youris.com about the challenges faced in treating the disease in Egypt and the path towards developing a vaccine.

Why has Egypt been hit so hard by hepatitis C?
Unfortunately as a result of a public health campaign in the 1960s and 1970s Egypt is facing the world’s largest known man-made epidemic. During that campaign re-use of needles resulted in 35% of the population becoming infected with hepatitis C.  Today 14% of the population is chronically infected with HCV genotype 4, the virus causing this type of Hepatitis C. This makes it possible to study both the disease in the chronic phase as well as the acute stage, because the infection rate is very high as well.

What would differentiating between self-healing patients and others mean for treatment?
It will bring the possibility of improving the management of patients.  A set of biomarkers has emerged that are not only important with respect to spontaneous clearance versus chronic disease but are also relevant to the management of patients during their chronic phase.

One of the expected impacts of our work is that this will establish a path toward development of new vaccines. That will be a long and difficult process but worthwhile because of the sheer number of incident infections.

Is current treatment of hepatitis C effective?
That is an ever changing story. The current therapy in Egypt remains pegylated interferon, given in combination with ribavirin. It is a 48-week treatment and it results in an approximately 50% cure.

In Egypt they are able to get it for approximately one thousand US dollars. It is expensive, and up to 35 thousand patients per year get treatment in the national treatment centres.  Total costs run up to €25 ($35) million .  And thanks to this treatment, nearly 17 thousand patients are cured, but sadly at the same time, there are about 125 thousands patients that are newly infected. They are losing ground.  Now there are newer drugs that are promising 85% to 90% cure, but it’s still unclear how they will be delivered to places like Egypt and how long it will take to implement treatment to between three to five million patients.  Right now, they are simply far too expensive with prices that can run up to a thousand dollars a day during an 80-day treatment.

What strategies should be adopted for finding a solution for HCV in developing countries?
Since we have been speaking about Egypt, I would like to highlight the need for a specific HCV genotype 4 vaccine. It is probably one of the few populations in the world where it really makes sense. And it is critically needed.  So, a vaccine is required first and foremost for Egypt.  As for other developing countries - we’ve now delivered an interesting set of biomarkers and ideas about biomarker implementation. This will have a potential impact on the management of HCV patients. And a new European project has just gotten underway, called PoC-HCV. There, we are trying to deliver point-of-care tests to revolutionize the clinical management of chronic HCV patients. This new project will focus on the Egyptian population but will be applicable to individuals in these sort of countries, in general.