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Introduction
Skills and Expertise
Current institution
Publications
Publications (280)
Despite available curative treatments, global rates of hepatitis C virus (HCV) infection persist with significant burden in low‐ and middle‐income countries (LMICs). Long‐acting (LA) antiviral products are in development. This study explored the challenges and opportunities in LA‐HCV treatment across three LMICs: Egypt, Ethiopia and India. The surv...
Background
Several HCC risk stratification scores were developed; however, none has been prospectively validated. The primary aim is to validate the clinical utility of six HCC risk scores in large prospective study of F3‐4 patients achieving SVR following DAAs according to EASL guidelines. The secondary aim is to explore whether individualized ris...
Egypt has long been overwhelmed by the hepatitis C virus (HCV) infection, and it used to be the country with the world’s highest prevalence rates. The disease had been a significant public health problem, affecting millions of Egyptians and posing severe economic and social challenges. By the early 2000s, it was estimated that around 10% of the Egy...
Obesity is a global health problem and has been increasing in Egypt over the last several decades. A national population screening program for hepatitis C included screening for obesity. Here we report the outcome of body mass index (BMI) calculation for the screened population and for patients with hepatitis C.
Methods Adults 18 years and older (a...
Purpose of Review
The study aims to provide an overview of hepatitis C virus (HCV) elimination strategies and actions to show the progression of elimination efforts and path to elimination criteria globally. Additionally, we will highlight barriers and challenges facing global elimination actions and propose recommendations to achieve this goal.
R...
The top 20 highest burdened countries (in disability-adjusted life years) account for more than 75% of the global burden
of viral hepatitis. An effective response in these 20 countries is crucial if global elimination targets are to be achieved. In
this update of the Lancet Gastroenterology & Hepatology Commission on accelerating the elimination of...
449
Background: Recent advances in systemic therapies have revolutionized the management of HCC. However, there is limited real-world data on treatment patterns and survival outcomes in pts with uHCC. OREIOS (NCT05239507) study determined the clinical characteristics, management patterns and survival outcomes in pts with uHCC from 12 countries acro...
Globally, hepatocellular carcinoma (HCC) is the fourth most common cause of death from cancer. The prevalence of this pathology, which has been on the rise in the last 30 years, has been predicted to continue increasing. HCC is the most common cause of cancer-related morbidity and mortality in Egypt and is also the most common cancer in males. Chro...
the Egyptian experience in screening and treatment of HCV that covered more than 60 million people and removed the burden of HCV from Egypt
Hepatocellular carcinoma (HCC) is a growing health concern projected to cross over a million cases worldwide by 2025. HCC presents a significant burden of disease in Middle East and North African (MENA) countries due to a high prevalence of risk factors such as hepatitis C and B infections and rising incidence of non-alcoholic steatohepatitis and n...
Summary
Background
The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the gen...
Background
Oral direct-acting antiviral (DAA) regimens for chronic hepatitis C virus (HCV) infection have greatly improved treatment efficacy, with sustained virological response (SVR) rates of > 95% for HCV monoinfected patients. However, hepatitis B virus (HBV)/HCV coinfection is more complex than monoinfection with HBV or HCV alone. We evaluated...
Background & aims
An estimated 38% of adults worldwide have NAFLD. From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised research agenda for the global fatty liver disease community of practice.
Methods
Nine co-chairs drafted...
Background & aims:
Egypt used to have one of the highest prevalences of HCV infection worldwide. The Egyptian Ministry of Health launched a national campaign for the detection and management of HCV to reduce its burden. This study aims to carry out a cost-effectiveness analysis to evaluate the costs and benefits of the Egyptian national screening...
TPS618
Background: A majority of patients with hepatocellular carcinoma (HCC) are diagnosed with unresectable disease due to extensive extrahepatic spread, presence of multifocal tumors, poor hepatic function or tumor location near major intrahepatic vessels. The treatment landscape for unresectable HCC is rapidly evolving with availability of nove...
Background and study aims:
Liver fibrosis is the underlying causeof hepatitis C virus (HCV)-related disease progression to endpoints such as cirrhosis, liver failure, and hepatocellular carcinoma. The aim of our study was to assess changes in hepatic fibrosis in patients with chronic HCV who had a fibrosis evaluation at two time points at least si...
Background and study aims
Little is known about the true prevalence of hepatitis B virus (HBV) coinfection in patients with hepatitis C virus (HCV). This multicenter nationwide study aimed to assess the seroprevalence of HBV among Egyptian patients with HCV and its possible risk factors.
Patients and methods
This is a cross-sectional, multicenter,...
Summary
Background Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic
started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination.
This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends....
Background
Metabolic‐associated fatty liver disease (MAFLD) was proposed in 2020 to identify fatty liver disease associated with metabolic risks. Metabolic abnormalities with hepatitis C virus (HCV) and MAFLD frequently co‐exists. However, data on the co‐existence are still lacking.
Aim
To explore the prevalence and characteristics of metabolic pr...
We have recently demonstrated the ability of a simple predictive model (GES) score to determine the risk of hepatocellular carcinoma (HCC) after using direct‐acting antivirals. However, our results were restricted to Egyptian patients with hepatitis C virus (HCV) genotype 4. Therefore, we studied a large, independent cohort of multiethnic populatio...
This review aims to develop an appropriate review tool for systematically collating metabolites that are dysregulated in disease and applies the method to identify novel diagnostic biomarkers for hepatocellular carcinoma (HCC). Studies that analysed metabolites in blood or urine samples where HCC was compared with comparison groups (healthy, pre-ci...
Background
Although Egypt was the country with the highest prevalence of hepatitis C in the world, the availability of sofosbuvir based therapies enabled Egypt to be the first country to eliminate hepatitis C and cure more than 4 million chronically infected patients.
Purpose
This is a small tribute to John Martin.
Methodology and conclusion
Here...
Background and study aims:
In resource-limited countries, non-invasive tests for assessing liver fibrosis are a potential alternative to costly endoscopic screening for esophageal varices. We aimed to validate several non-invasive parameters for predicting the presence of varices.
Patients and methods:
Between September 2006 and August 2017, a t...
The landscape of chronic liver disease in Egypt has drastically changed over the past few decades. The prevalence of metabolic-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the magnitude of the problem, no regional guidelines have been developed to tackle this disease. This document provides the clinical practice guid...
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 coun...
We report a case of hepatic lymphoepithelioma-like carcinoma-hepatocellular carcinoma subtype (LEL-HCC) in a 41-year-old man with chronic hepatitis C virus (HCV) infection. The patient presented with abdominal pain and further assessment revealed a hypoechoic mass on ultrasonography. Serum alpha-fetoprotein (AFP) was 13·6 ng/dl. The patient was dia...
Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other...
Acute fatty liver of pregnancy (AFLP) and acute pancreatitis are peculiar complications of pregnancy. When acute pancreatitis occurs co-incidentally with acute fatty liver of pregnancy, mortality is high. Here, we report a case of a 22-year-old lady in her 36th week of gestation, who presented with pre-eclampsia, acute fatty liver of pregnancy and...
Background and Aim
Existing data are controversial regarding the incidence of hepatitis C (HCV)–related hepatocellular carcinoma (HCC) following directly acting antiviral (DAA) therapy. This prospective study aimed to assess incidence, and risk factorss of HCC following DAA therapy in patients with HCV-related advanced fibrosis (F3) and cirrhosis (...
Background:
Only a few treatments are approved for COVID-19 infections, with continuous debate about their clinical impact. Repurposing antiviral treatments might prove the fastest way to identify effective therapy.
Objectives:
This trial aimed to evaluate the efficacy and safety of sofosbuvir (SOF) plus daclatasvir (DCV) or ravidasvir (RDV) add...
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 retrospect...
Telemedicine is a novel tool that could assist in the delivery of medical care, therefore, we aimed to assess the utility of using telemedicine in the Egyptian hepatitis C (HCV) treatment program to provide care to patients in remote areas. A telemedicine viral hepatitis treatment center was established in the Bahariya Oases, a remote area in the E...
Access to recommended second-line treatments is limited for patients who fail initial HCV therapy in low- and middle-income countries. Alternative regimens and associated outcomes are not well understood. Through a pooled analysis of national program data in Egypt, Georgia, and Myanmar, we observed SVR rates >90% for alternative retreatment regimen...
Effective oral combination regimens have been approved for treatment of hepatitis C virus (HCV) infection and demonstrated high cure rates in different HCV genotypes. These direct-acting agents target a variety of HCV proteins, including HCV-NS5A (nonstructural protein 5A). Ravidasvir hydrochloride, a potent pan-genotypic HCV-NS5A inhibitor approve...
The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. T...
Objectives: The extent of post-treatment fibrosis change in patients with different stages of fibrosis is not fully known. The authors aimed to study changes in liver fibrosis in chronic hepatitis C patients who were treated with pegylated interferon/ribavirin (PEG/RBV) or direct acting antivirals (DAAs).
Methods: Retrospective evaluation of result...
Background
Large-volume paracentesis (LVP) is a main pillar in treating patients with tense ascites. Without plasma expanders use, paracentesis-induced circulatory dysfunction (PICD) is a common complication with decreased survival. The aim was to compare low-dose albumin (2 g/L ascitic fluid removed n = 85) with standard-dose albumin (6 g/L asciti...
Background
Ascites is one of the main complications of advanced liver cirrhosis. It is defined as a pathological accumulation if free fluid in the peritoneal cavity.
Main body of the abstract
Ascites is a sign of decompensation in patients with liver cirrhosis and is associated with decreased survival. Ascites is associated with bad cosmetic figur...
With the increasing prevalence of obesity and type 2 diabetes, fatty liver disease associated with metabolic dysfunction is a global health problem, especially because it is one of the earliest consequences of obesity and it precedes diabetes development. Fatty liver disease associated with metabolic dysfunction is of particular concern in the Midd...
Background & aims:
Hepatocellular carcinoma (HCC) risk persists after hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs), particularly in patients with liver cirrhosis. Identifying those who are likely to develop HCC is a critical unmet medical need. Our aim is to develop a score that offers individualized patient HCC risk pr...
Variations in the immune response could explain resistance to hepatitis C virus (HCV) infection. Toll-like receptor gene (TLR)-3 is an innate detector of dsRNA viruses, and the TLR9 gene recognizes bacterial and viral unmethylated CpG motifs. We previously reported that TLR3.rs3775290 CC genotype was associated with HCV chronicity and that the TLR9...
The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. T...
Background & Aims
COVID-19 has placed significant strain on national healthcare systems at a critical moment in the context of hepatitis elimination. Mathematical models can be used to evaluate the possible impact of programmatic delays on hepatitis disease burden. The objective of this analysis was to evaluate the incremental change in hepatitis C...
Background: The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of...
In medicine, language matters and the words used to name and describe a disease can have a profound impact on patients and their families. Over the last two decades, many criticisms have been voiced about the nomenclature and definition of non‐alcoholic fatty liver disease (NAFLD) in regards not only to the prominent role that alcohol plays in the...
BACKGROUND
The albumin-bilirubin (ALBI) score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma. Incorporating platelet count in the platelet-albumin-bilirubin (PALBI) score improved validity in predicting outcome of patients undergoing resection and ablation.
AIM
To evaluate the PALBI score in pre...
Background:
Chronic hepatitis C (CHC) is a leading cause of liver fibrosis.
Objective:
To compare utility of liver transient elastography, AST-to-platelet ratio index (APRI), fibrosis-4 index (FIB4), Forns Index and Goteborg University cirrhosis index (GUCI) in predicting fibrosis stage assessed by liver biopsy in Egyptian CHC patients.
Methods...
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Background and aims:
The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer i...
Background: The impact of patient cure by direct-acting antiviral agents (DAAs) on female sexual dysfunction (FSD) associated with HCV hasn’t been studied.
Aim: To study the impact of DAAs on associated FSD in patients with chronic HCV infection.
Methods: In patients with chronic HCV infection who were eligible for DAAs, the self-administered femal...
Objectives: To assess the role of baseline liver stiffness (LS) by Transient elastography (TE) and FIB-4 in the prediction of virological response to sofosbuvir – based regimens in chronic HCV patients.
Methods: A retrospective, multicenter study including 7256 chronic HCV patients who received different sofosbuvir–based regimens. Baseline demograp...
Background: There is strong link between hepatitis C virus (HCV) infection and the insulin resistance panel. Homeostatic model assessment (HOMA) β is an indirect measurement of insulin secretion from pancreatic β cells, while HOMA-S accounts for insulin sensitivity.
Aim: We examined the impact of HCV treatment with direct acting antivirals (DAAs) o...
It is well known that intermediate stage hepatocellular carcinoma (HCC) encompasses the widest class of patients with this disease. The main characteristic of this special sub-group of patients is that it is extensively heterogenous. This substantial heterogeneity is due to the wide range of liver functions of such patients and variable tumor numbe...
BACKGROUND
An ideal staging system for hepatocellular carcinoma (HCC) should rely on the hepatic reserve function and tumor burden. With the improvement in diagnostic and treatment strategies for HCC, in addition to recent treatment of viral hepatitis, finding a suitable assessment tool for hepatic reserve has become mandatory.
AIM
To validate a r...
Aim: Evaluation of the efficacy and safety of sofosbuvir/daclatasvir/ribavirin (SOF/DCV/RBV) in treating non-sustained virological responders (non-SVR12) to prior sofosbuvir-based therapy, in absence of RAS testing in mass treatment, and determination of the optimal timing to start re-treatment.
Methods: Real-life prospective observational study in...
Background Cytotoxic chemotherapy is generally ineffective in patients with hepatocellular carcinoma. We assessed the intravenous perfusion of doxorubicin-loaded nanoparticles in patients with hepatocellular carcinoma in whom previous sorafenib therapy had failed.
Background:
Cytotoxic chemotherapy is generally ineffective in patients with hepatocellular carcinoma. We assessed the intravenous perfusion of doxorubicin-loaded nanoparticles in patients with hepatocellular carcinoma in whom previous sorafenib therapy had failed.
Methods:
We did a multicentre, open-label, randomised, controlled phase 3 trial a...
Background
Upper gastrointestinal bleeding (UGIB) is a serious complication of portal hypertension in cirrhotic patients.
Objective
to identify the risk factors for morbidity and mortality occurring after an UGIB attack.
Methods
A total of 1,097 UGIB attacks in 690 patients with liver cirrhosis were studied. Their clinical, laboratory and endosco...
Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WH...
Previous studies showed that interleukin (IL)-28B gene polymorphisms were associated with hepatitis C Virus (HCV) infection and treatment outcomes. We tested whether single-nucleotide polymorphisms (SNPs) in IL-28A and IL-28B are associated with HCV infection among Egyptians with HCV genotype 4 infections. We enrolled 144 chronic HCV patients, 72 s...
Abstract:
(link to our online calculator: https://jscalc.io/calc/gdEJj89Wz5PirkSL)
Background & Aims
It is important to rapidly identify patients with advanced liver disease. Routine tests to assess liver function and fibrosis provide data that can be used to determine patients’ prognoses. We tested the validated the ability of combined data fro...
Chronic infection with hepatitis C virus (HCV) is a global health challenge with over 75 million people affected globally. The widespread transmission of the virus in the past century has created a large infectious reservoir, especially in low- and middle-income countries (LMICs). There remain 1–2 million new HCV infections worldwide every year.
Background
Phase II trials found that tegafur–uracil (UFT) is an effective drug in hepatocellular carcinoma (HCC), while preclinical data suggested that its combination with sorafenib may have a promising activity. Our Phase II randomized trial aimed to evaluate efficacy and tolerability of sorafenib plus UFT vs sorafenib in advanced HCC.
Methods...
Toll-like receptors (TLRs) give the innate immune system a considerable specificity for a large range of pathogens. TLR3 detects dsRNA of viruses while TLR9 recognizes bacterial and viral unmethylated CpG motifs. This study examined whether there is a potential association between single-nucleotide polymorphisms (SNPs) in the TLR3.rs3775290 (c.1377...
Background:
Direct acting antivirals (DAAs) are highly effective for treatment of hepatitis C (HCV) but brand products are priced beyond the means of most low and middle income countries (LMICs). Although a few DAAs are offered at reduced prices in access programs, yet are still beyond the affordability in limited resource settings with large HCV...
For many years the definition of 'health' has remained unchanged as a narrow concept, encompassing physical wellbeing from a medical context. This somewhat focused definition has attracted criticism from individuals and professional bodies alike. Recent attempts have been made to redefine health, each offering an alternative viewpoint from sociolog...
Introduction and aim:
The interleukin-2 receptor antagonist; basiliximab is used to allow delayed introduction of Calcineurin inhibitors (CNI) after liver transplantation and thus delay their renal insult. However, there is only little evidence for the safety and the efficacy of this regimen. This study aimed to evaluate the effectiveness and safe...
Acute Hepatitis C (AHC) infections, resolves spontaneously in 15‐40% of patients. Factors favoring spontaneous viral clearance remain undefined. In this study, predictors of spontaneous viral clearance in symptomatic AHC patients were investigated. Epidemiological, clinical and virologic parameters were also examined. Symptomatic AHC patients were...
en Linked Content
This article is linked to Butt et al paper. To view this article visit https://doi.org/10.1111/apt.14799.
Background:
Insulin resistance (IR) is a common complication in chronic hepatitis C virus (HCV) patients. The impact of IR on outcome of therapy with direct antivirals has not been studied.
Aim:
The aim was to assess the impact of direct-acting antiviral (DAA) therapy on IR status in chronic HCV patients.
Patients and methods:
A total of 511 p...
Background: In AGATE‐II, treatment with ombitasvir co‐formulated with paritaprevir/ritonavir plus ribavirin (RBV) in Egyptians infected with hepatitis C virus genotype 4 (HCV GT4) resulted in high rates of sustained virologic response at Post‐Treatment Week 12. This subanalysis examined the effects of treatment in AGATE‐II on liver biomarkers in pa...
Objective
We evaluated the efficacy and safety of ledipasvir/sofosbuvir alone and with ribavirin for 8 and 12 weeks in Egyptian patients with and without cirrhosis, who were infected with hepatitis C virus (HCV) genotype 4, including those who had failed previous treatment with sofosbuvir regimens.
Design
In this open-label, multicentre, phase III...
Background
The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. Although no virological cure exists for hepatitis B virus (HBV) infection, existing therapies to control viral replication and prophylaxis to minimise mother-to-child transmission make elimination of HBV feasible. We aimed to e...
Background and study aims:
In this study we assessed rates and determinants of survival in people with untreated chronic HCV infection and hepatocellular carcinoma (HCC) in an Egyptian liver clinic setting.
Patients and methods:
This is a prospective cohort study of patients diagnosed with HCV-related HCC and undergoing HCC management at a natio...
Hepatitis C virus (HCV) infection is a global health problem whose management has been markedly improved with the introduction of direct-acting antivirals (DAAs). Ravidasvir is a novel DAA agent that inhibits key viral functions through inhibition of the viral nonstructural protein 5A (NS5A). Ravidasvir is being developed by Presidio Pharmaceutical...
Background and aim:
The introduction of direct acting antivirals for HCV in Egypt led to massive treatment uptake to become the largest HCV treatment program worldwide. The aim of this paper is to present the Egyptian experience in planning and prioritizing mass treatment for HCV patients, highlighting the difficulties and limitations of the progr...
