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. 2023 Feb 13;13:2499. doi: 10.1038/s41598-023-29262-z

Gender differences in prevalence of hepatitis C virus infection in Egypt: a systematic review and meta-analysis

Muhammad Abdel-Gawad 1, Mohamed Nour 2,3, Fathiya El-Raey 4, Hanaa Nagdy 5, Yahya Almansoury 6, Mohamed El-Kassas 7,✉
PMCID: PMC9925441  PMID: 36781919

Abstract

Egypt is the country with the highest known hepatitis C virus (HCV) prevalence worldwide. The origin of gender differences in HCV prevalence is not usually well understood. This systematic review and meta-analysis aimed to review and evaluate the gender differences in HCV infection rates amongst Egyptians. Such data would be important to support prevention and control programs aiming to minimize HCV-related morbidity and mortality. PubMed, Scopus, and Web of Science (WOS) were searched for relevant articles published from 1st January 2011 to 13th December 2021, using the search terms (HCV OR “hepatitis C” OR hepacivirus) AND (prevalence OR seroprevalence OR epidemiology OR incidence OR magnitude). At first, retrieved articles were screened, and then relevant data were extracted and analyzed. Descriptive statistics were used for data analysis. Out of 616 studies from databases, only 30 were included after the full-text screening, with 193,621 included participants: 97,597 male and 96,024 female. The overall seroprevalence of HCV antibodies in all included studies was 0.02 (CI − 0.23 to 0.28), with no significant difference between males and females. However, HCV RNA positivity was significantly more prevalent in males than females in adults and the general population (after excluding high-risk groups). In children, no statistically significant differences between males and females were found in the seroprevalence of HCV antibodies nor in the prevalence of PCR positivity. HCV RNA positivity is significantly higher in males than females in adults, while there are no gender differences in children.

Subject terms: Gastroenterology, Health care, Medical research

Introduction

Hepatitis C virus (HCV) infection is a significant public health concern and, regrettably, a major cause of liver-related morbidity and mortality that challenges healthcare systems in many countries. Globally, 1.5 (1.3–1.8) million people are newly infected with HCV every year, and 58 (46–76) million people are living with chronic HCV infection, with a global prevalence of 0.8% (0.6–1.0%) in the general population. The highest prevalence in the Eastern Mediterranean Region is 1.6% (1.4–1.8%), 290,000 (230,000–580,000) people die from hepatitis C-related causes every year, and only 21% of people are diagnosed with HCV infection, and 62% of them receive treatment1.

Gender is an essential determinant of social outcomes, including health. Research has shown a growing interest in health-related gender differences and raises the question of gender-biased differential response that is relevant in many health fields, including the prevalence, risk factors, clinical features, and treatment of diseases. Still, the epidemiological pattern of HCV infection in research and medical practice requires further knowledge of the potential role of gender differences. Thus, assessing gender-level change in HCV prevalence may help identify population subgroups most likely to suffer an increased infection rate, thus enabling health authorities to plan targeted interventions for these changes2.

The origin of gender differences in HCV prevalence is not well understood, and some hypotheses tried to explain this difference. The salience of gender in positioning women at increased risk of exposure to HCV infection has been confirmed by some studies3–6, while others support the view that HCV infection appears to be prevalent and progresses more rapidly in males than in females7–11. On the other hand, some studies found gender differences are artifactual, with nearly flat rates of HCV infection12–15. Also, some studies found a decreased rate of liver cirrhosis and hepatocellular carcinoma (HCC) in females16, more progress to hepatic fibrosis in males, and more liability to adverse events of direct-acting antivirals (DAAs) in females17.

Compared to men, women are more exposed to syringes, blood, and blood products, especially during pregnancy and labor, and ear piercing, and thus run a higher risk of HCV infection. Biological sex with female predominance has been associated with differences in rates of spontaneous HCV clearance, with a possible role of sex hormones in determining host susceptibility to viral infections18. On the other hand, male predominance can be explained by differences in daily life conditions, environmental experiences, and social, cultural, and occupational aspects taken up more frequently by men than women, especially in marginalized groups and slum areas such as IV drug use, circumcision, shared use of toothbrushes or shaving razors, tattooing, wet cupping (Higama), or illegal sexual intercourse, in addition to blood transfusion emergencies19. The hormonal hypothesis and other mechanisms have been invoked, such as cellular mosaicism, genes escaping X chromosome inactivation, skewed X chromosome inactivation, and miRNAs encoded on the X chromosome20. In addition, gender differences in HCV infection rates might reflect differences in the patterns of gender-specific risky behaviors21,22.

Historically, Egypt is one of the world countries with the highest prevalence of HCV infection. Over the past decade, Egypt has continued efforts to achieve HCV control and works towards the common goal, targeted by the WHO, of the elimination of viral hepatitis by 2030. The universal access to treatment with the introduction of DAAs has resulted in a paradigm shift in HCV management and declining mortality. A large Egyptian study showed a marked decrease in mortality in Egypt23.

In Egypt, some studies indicated that anti-HCV prevalence in the general population was higher in males than in females (19.67% vs. 9.73%; p < 0.001)10, (16.1% vs. 13.4%; p < 0.001)9, and (7.5% vs. 5.3%; p < 0.001)8. While other studies found more anti-HCV prevalence in women than in men in special situations: (13.4% vs. 7.3%; p = 0.045) among family contacts of HCV-positive children24, (25.2% vs. 17.6%; p = 0.031) in patients with coronary heart disease5, and (25.1% vs. 15%; p = 0.002) in apparently healthy blood donors3.

We aimed to review and evaluate the dominance of gender in HCV infection and whether gender differences in HCV seroprevalence and HCV RNA exist amongst Egyptians that can support prevention and control programs and minimize HCV-related morbidity and mortality.

Methods

To conduct this meta-analysis, we searched PubMed, Scopus, and Web of Science (WOS) for relevant articles published from 1st January 2011 to 13th December 2021. Our protocol was registered to the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022303921).

Search strategy

We searched the target databases one by one using the following search terms: (HCV OR “hepatitis C” OR hepacivirus) AND (prevalence OR seroprevalence OR epidemiology OR incidence OR magnitude).

Eligibility criteria

Any Egyptian observational cross-sectional study containing original information regarding the prevalence of HCV on both males and females published in the English language from 2011 or later till the end of 2021 was included irrespective of the governorate, studied group, and age of participants. Studies that did not specify gender, non-Egyptian studies, studies with a mixed population with no definite data for Egyptians, studies in which prevalence was not the primary concern, editorials, reviews, abstracts, posters, commentaries, and non-human studies were excluded.

Screening, data extraction, and quality assessment

Title and abstract screening were done by four independent reviewers (MO, YA, HN, FA), and a discussion with the research team solved any disagreements. The same four independent reviewers did full-text screening for articles selected in the previous step. Data extraction for finally included studies retrieved from the full-text screening was done independently. Relevant data were extracted to a pre-prepared excel file. Quality assessment was done by two independent reviewers (MA, MA). We used The Joanna Briggs Institute (JBI)25 tool for the quality assessment of prevalence studies.

Data synthesis and analysis

Collected data were analyzed using STATA version 16 (Stata Crop LP). Heterogeneity was assessed using the I2 test and classified as high, moderate, and low heterogeneity according to I2; more than 75%, 50%, or 25%, respectively. A log odds ratio with a 95% confidence interval (CI) was used with a random effect model to compare males and females. A funnel plot was used to check for publication bias using egger's test (a p value less than 0.05 was considered significant) (Supplementary Fig. 1).

Results

Overview of included studies

Our primary search results yielded 616 studies from databases; 89 duplicated studies were excluded. By title and abstract screening, 308 studies were selected and entered the full-text screening. Only 30 studies3–5,8–10,12–15,24,26–44 were finally included in our meta-analysis after full-text screening (Fig. 1) with 193,621 included participants: 97,597 male and 96,024 female. Studies ranged from modest to high quality. Characteristics of the included studies are detailed in Table 1.

Figure 1.

Figure 1

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PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only.

Table 1.

Characteristics of finally included studies.

Authors Year Region Study type Used test Studied population Age Age group Participants Males Females Overall HCV Antibodies Overall PCR positivity Males HCV Antibodies Males PCR positivity Females HCV Antibodies Females PCR positivity
El-Faramawy 2012 2012 Qena Governorate Cross sectional Second generation ELISA Multitransfused children 8.29 ± 3.16 Children 100 68 32 45 32 13
El Garf 2012 2012 Cairo University Hospital Cross sectional Third generation ELISA Hospitalized patients 32.7 ± 13.1 (12–69) Mixed 157 24 133 29 15 4 25
Awadalla 2011 2011 Cairo University Hospital Cross sectional ELISA Blood donors 18–60 Adults 1000 825 175 168 124 44
Abdelwahab 2011 2011 National Liver Institute, Menufia Cross sectional Third generation ELISA Health Care Workers 31.5 ± 9.4 Adults 842 384 458 140 101 92 48
Abd Elrazek 2014 2014 Several medical canters in urban and rural areas across Egypt Cross sectional ELISA and PCR General population 17–58 Adults 6660 3836 2824 1580 1018 627 391
Talaat 2019 2019 Abbasia, Alexandria, Helwan, Menouf, and Aswan Cross sectional ELISA Suspected hepatitis (1–90) mean 13.9 Mixed 9321 5471 3850 252 191 61
Soliman 2019 2019 Luxor Cross sectional Third generation ELISA General population Mean 43.6 years, Median 43 years, and Range 22 years, Adults 67,042 31,965 35,077 9701 6288 3413
Sherief 2021 2021 Menoufia and Sharkia Cross sectional ELISA and PCR Multitransfused children 9.9 ± 5.1 Children 477 262 215 70 69 38 37 32 32
Sherief 1 2019 2019 Sharkia Cross sectional ELISA and PCR Relatives of oncology patients 18,537 Mixed 450 204 246 48 57 15 33
Dahab 2019 2019 Magrabi eye hospital, Cairo Cross sectional rapid chromatography immunoassay Ocular surgery patients 50.85 ± 19.77 Adults 3067 1592 1475 380 380 215 166
Anwar 2021 2021 Ain Shams University Hospitals Cross sectional ELISA Hospitalized patients 54.35 ± 14.46 Adults 500 288 212 99 67 32
Anwar1 2021 2021 Health-care workers of Ain Shams University hospitals Cross sectional ELISA Health Care Workers Adults 50 17 33 4 1 3
Ahmed 2020 2020 Qena Cross sectional ELISA Blood donors Adults 11,604 10,232 1372 370 326 326
Abo-Amer 2018 2018

Lower Egypt, n = 47,344 (97%)

Male, n = 21,365

Female, n = 25,979

Upper Egypt, n = 1448 (3%)

Male, n = 6

Female, n = 1442

 Cross sectional ELISA and PCR University students 18 ± 0.056 Adults 48,792 21,371 27,421 498 194 147 304 208
Mohlman 2015 2015

Birthplace

Urban 16.7%

Rural 37.5%

Residence at time of interview

Urban 22.2

Rural 36.9%

 Cross sectional ELISA and PCR Control group of hepatocellular Carcinoma patients > 17 Adults 1764 1094 670 525 404 352 169
Abdelmoemen 2018 2018 Tanta University Hospitals Cross sectional HCV RNA viral load in the plasma and PBMCs by standardized quantitative real-time PCR Haemodialysis patients 44.5 ± 13.8 Adults 62 35 27 3 2 1
Abd El Salam 2016 2016 Zagazig University Hospitals, Sharkia Cross sectional HCV Antibodies Coronary artery disease patients 53.37 ± 8.36 Adults 344 375 206 118 66 52
Mansour 2012 2012 Dakahlia, Mansoura University Children’s Hospital HCV Antibodies Multitransfused children 13 (11 month-19 year) Children 200 111 89 81 42 39
Esmat 2016 2016 Upper Egypt and Lower Egypt undergraduate students at the Cairo University Hospital Serum HCV Antibodies and quantification of HCV load in serum University students 18.1 ± 0.7 Adults 3000 1340 1660 137 43 51 29 86 14
Emam 2015 2015 Sharkia HCV antibodies Elderly population 64.37 ± 4.74 Adults 214 115 99 60 32 28
Elhendawy 2020 2020 Gharbia, Basyoun, village of Nagreej Prospective cohort PCR General population 18–60 Adults 2048 930 1118 542 505 282 223
El-Ghitany 2019 2019 21 Governorates: Alexandria, Asyut, Beheira, Beni suef, Cairo, Dakahlia, Damietta, Faiyum, Gharbia, Giza, Ismailia, Kafr El-Sheikh, Luxor, Marsa matruh, Menoufeya, Minya, Port Said, Qalubeya, Sharqeya, Sohag, Suez Cross sectional Serum HCV Antibodies and quantification of HCV RNA load in serum General population 38.95 ± 13.3 (14–90) Mixed 12,169 6170 5999 1795 1070 993 802
El Garf 2013 2013 Cairo University Hospitals Cohort Serum HCV Antibodies and quantification of HCV RNA load in serum SLE patients 14–63 (26.5) Mixed 98 11 87 20 8 2 18
Edris 2014 2014 Damietta Cross sectional HCV antibodies General population 33.9 ± 15.6 Mixed 2977 1621 1356 278 160 118
El Feki 2013 2013 Beni-Suef Cross sectional Serum HCV Antibodies and quantification of HCV RNA load in serum General population 15–70 Adults 400 235 165 144 136 84 60
El Batae 2018 2018 Kafr El Sheikh University Cross Sectional PCR University students 18.6 ± 0.39 Adults 9049 4233 4816 25 24 13 11
Barakat and El-Bashir 2011 2011 representative sample Serum HCV Antibodies and quantification of HCV RNA load in serum General population 6–15 years Children 500 254 246 29 22 18 11
Abd El-Wahab 2016 2016 Alexandria Cross sectional Serum HCV Antibodies and quantification of HCV RNA load in serum School children 6 and 15 years Children 500 284 216 14 8 6
Ibrahim 2016 2016 Electricity generating company in Mansoura Cross sectional HCV Antibodies General population 21–62 (40.61) Adults 258 216 42 38 36 2
MOH Survey 2015 2015 All over Egypt Cross sectional ELISA and PCR General population 1–59 years Mixed 27,549 13,068 14,481 1735 1212 980 692 767 521
1–14 years Children 10,878 5606 5272 43 21 39 11 10 5
15–59 years Adults 16,671 7462 9209 1667 1166 925 664 745 506
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The overall gender differences in the seroprevalence of HCV antibodies (all included studies)

The seroprevalence of HCV antibodies among the Egyptian population using serum antibodies test by ELISA, based on the results of the random-effects method, there were no significant differences between male and female seroprevalence of HCV. The overall seroprevalence was 0.02 (log 95% CI − 0.23, 0.28), and the heterogeneity was high (T2 = 0.35, I2 = 96.99, H2 = 33.21, p value = 0.86) as shown in Fig. 2.

Figure 2.

Figure 2

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Forest plot of seroprevalence of HCV antibodies in males and females. There is no significant difference in seroprevalence of HCV antibodies between males and females.

Gender differences in the prevalence of HCV PCR positivity

Eight studies used PCR to measure the prevalence of HCV; based on the results of the random-effects method of these studies, there was a statistically significant increase in the prevalence of HCV RNA positivity in males than females (0.25, log 95% CI 0.04–0.46) and the heterogeneity was high (T2 = 0.05, I2 = 78.48, H2 = 4.65, p value = 0.02) as shown in Fig. 3.

Figure 3.

Figure 3

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Forest plot of prevalence of HCV RNA in males and females. There is statistically significant increase in prevalence of HCV RNA positivity in males than females.

Subgroup analysis of gender differences

Children versus adults

In children, there were no statistically significant differences in the seroprevalence of HCV antibodies or prevalence of PCR positivity (Figs. 4, 5).

Figure 4.

Figure 4

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Forest plot of seroprevalence of HCV antibodies in males and females in children. There is no significant difference between males and females in HCV antibodies prevalence.

Figure 5.

Figure 5

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Forest plot of prevalence of HCV RNA in males and females in children. There is no significant difference between males and females in HCV RNA prevalence in children.

In adults, there were no significant differences in the seroprevalence of HCV antibodies between males and females. At the same time, HCV PCR testing showed a significant increase in the male prevalence of HCV PCR positivity to females (0.31, log 95% CI 0.07–0.56), and the heterogeneity was high (T2 = 0.07, I2 = 84.32, H2 = 6.38, p value = 0.01) (Figs. 6, 7).

Figure 6.

Figure 6

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Forest plot of seroprevalence of HCV antibodies in males and females in adults. There is no significant difference in seroprevalence of HCV antibodies between males and females in adults.

Figure 7.

Figure 7

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Forest plot of prevalence of HCV RNA in males and females in adults. There is statistically significant increase in prevalence of HCV RNA in males than females in adults.

General population

By studying gender prevalence differences in studies conducted on the general population (with no risk factors) after excluding studies on high-risk groups, males showed a significantly increased prevalence of both HCV antibodies and HCV PCR positivity (Supplementary Figs. 2, 3).

Discussion

Gender-based differences vary by country and region. This study presents a comprehensive update on HCV infection gender differences in Egypt. Despite the historic large-scale epidemic in Egypt, HCV antibody incidence and prevalence appear to decline rapidly, consistent with a contracting epidemic. In 2006, the national treatment strategy for the control of HCV infection in Egypt was established in response to the magnitude of the HCV problem and the disease burden in Egypt45.

Egypt is the country with the highest HCV prevalence worldwide. Six percent of individuals aged 1–59 years had a positive result on the hepatitis C antibody test, and 4% were found to have an active infection. The prevalence of hepatitis C was higher among men than women in most age groups8. This finding agreed with the results of this meta-analysis in all studies conducted on the general population (26 studies).

There is limited published data on gender-based differences in children46. The worldwide pooled seroprevalence of HCV in children in these studies was low, < 1%47. In 2015, the Egyptian Demographic and Health Surveys (EDHS) tested 10,044 children (5154 male and 4890 female) to estimate HCV prevalence in those aged 1–14. The results showed that HCV prevalence in the group aged < 15 years was 0.4%. HCV antibody seroprevalence was 0.7% with viremia of 0.2% in male children, while HCV antibody was seroprevalent in 0.2% with the presence of viremia in 0.1% of female children10. The current meta-analysis shows no significant differences between male and female children in HCV antibody prevalence or viremia.

The EDHS reported that seroprevalence of HCV antibodies was 14.7% among the adult population aged 15–59 years at 14.7% with a national viremic prevalence of 9.7%, which was higher in males than in females in all studied age groups in 200848. Similarly, the results of this meta-analysis showed that the prevalence of HCV viremia was significantly higher in males than females in adults. This difference may be attributed to males being more affected by schistosomiasis disease burden and hence were the main target of the parenteral antischistosomal therapy (PAT) campaign49 with high risk for parenteral virus transmission, including HCV. Also, the lifestyle of males makes them more exposed to various risk factors for HCV transmission50.

In 2015, there was significantly lower HCV prevalence in those aged 15–19 years compared to the 2008 data (14%), and this points to a significant decrease in new infections in the age groups 15–19 years51. Total HCV seroprevalence in the age groups 15–59 years was 10%, with a viremic prevalence of 7%. HCV seroprevalence in female adults was 8.1%, with viremia of 5.5%, while HCV seroprevalence in male adults was 12.4%, with a viremic prevalence of 9.8%8.

Study limitations

There were not enough data from the included studies to determine the sources of heterogeneity. It may be due to differences in populations, regions, geographical locations, seasons, settings (rural or urban), and used screening methods. Unmeasured covariates (such as population characteristics, presence of comorbidities, HIV status, etc.) could have contributed to variability in outcome estimates. Gender differences among high-risk populations (e.g., healthcare workers, drug users, incarcerated populations, people living with HIV, etc.) were not considered in this study to avoid overestimating the problem.

Conclusion

HCV RNA positivity is significantly higher in males than females in adults, while there are no gender differences in children.

Supplementary Information

Supplementary Figures. (35.2KB, docx)

Author contributions

The study was conceptualized by M.E.K., M.N. and M.A.G. F.E., Y.A., and H.N. collected study data. Data analysis was done by M.A.G. M.A.G. F.E., Y.A., M.N., and H.N. wrote the first draft of the article. All authors contributed to the reviewing and editing of the article and approved the final version. Article preparation was done by all study authors and the decision to submit the Article for publication was made by all study authors.

Funding

Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-023-29262-z.

References

  • 1.Organization WH. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021: Accountability for the global health sector strategies 2016–2021: Actions for impact: Web annex 2: Data methods [Internet]. Geneva PP - Geneva: World Health Organization; 2021. https://apps.who.int/iris/handle/10665/342813.
  • 2.Regitz-Zagrosek V. Sex and gender differences in health. Science & society series on sex and science. EMBO Rep. [Internet] 2012;13(7):596–603. doi: 10.1038/embor.2012.87. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Awadalla HI, Ragab MH, Nassar NA, Osman MAH. Risk factors of hepatitis C infection among Egyptian blood donors. Cent. Eur. J. Public Health [Internet] 2011;19(4):217–221. doi: 10.21101/cejph.a3628. [DOI] [PubMed] [Google Scholar]
  • 4.Esmat G, El RM, Nabeel MM, Maher R, Zakaria Z. Seroprevalence of HCV among Cairo University students in Egypt. J. Med. Virol. 2016;88(8):1384–1387. doi: 10.1002/jmv.24469. [DOI] [PubMed] [Google Scholar]
  • 5.El Salam RA, Nabil B, Saber M, Abdelwahab HA, Saber T. Prevalence of hepatitis C virus seropositivity and its impact on coronary artery disease among Egyptian patients referred for coronary angiography. Cardiol. Res. Pract. 2016 doi: 10.1155/2016/1623197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Chaabna K, Dashzeveg D, Shagdarsuren T, Al-Rifai RH. Prevalence and genotype distribution of hepatitis C virus in Mongolia: Systematic review and meta-analysis. Int. J. Infect. Dis. [Internet] 2021;105:377–388. doi: 10.1016/j.ijid.2021.02.040. [DOI] [PubMed] [Google Scholar]
  • 7.Cornberg M, Razavi HA, Alberti A, Bernasconi E, Buti M, Cooper C, et al. A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel. Liver Int. 2011;31(SUPPL. 2):30–60. doi: 10.1111/j.1478-3231.2011.02539.x. [DOI] [PubMed] [Google Scholar]
  • 8.Ministry of Health and Population [Egypt], El-Zanaty and Associates [Egypt], and ICF International. Egypt Health Issues Survey 2015, 234 (2015).
  • 9.El-Ghitany EM, Farghaly AG. Geospatial epidemiology of hepatitis C infection in Egypt 2017 by governorate. Heliyon [Internet] 2019;5(8):e02249. doi: 10.1016/j.heliyon.2019.e02249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Soliman G, Elzalabany MS, Hassanein T, Miller FDW. Mass screening for hepatitis B and C in Southern Upper Egypt. BMC Public Health. 2019;19(1):1–7. doi: 10.1186/s12889-019-7640-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Sedeño-Monge V, Laguna-Meraz S, Santos-López G, Panduro A, Sosa-Jurado F, Jose-Abrego A, et al. A comprehensive update of the status of hepatitis C virus (HCV) infection in Mexico—A systematic review and meta-analysis (2008–2019) Ann. Hepatol. 2021;20:100292. doi: 10.1016/j.aohep.2020.100292. [DOI] [PubMed] [Google Scholar]
  • 12.El Garf A, Shaheen N, Gaber W, Sobhy N. Prevalence and impact of chronic hepatitis C virus infection on the clinical manifestations and disease activity among patients suffering from systemic lupus erythematosus. Egypt Rheumatol. [Internet] 2013;35(1):9–14. doi: 10.1016/j.ejr.2012.09.003. [DOI] [Google Scholar]
  • 13.Edris A, Nour MO, Zedan OO, Mansour AE, Ghandour AA, Omran T. Seroprevalence and risk factors for hepatitis B and C virus infection in Damietta Governorat,e Egypt. East Mediterr. Health J. 2014;20(10):605–613. doi: 10.26719/2014.20.10.605. [DOI] [PubMed] [Google Scholar]
  • 14.Emam M, Radwan MI, Refaey MM, Shaheen NE, Abd-Elmoez S, Gerges MA. Prevalence of hepatitis C virus in an elderly population in rural areas of Sharkia governorate, Egypt. Egypt Liver J. 2015;5(2):29–33. doi: 10.1097/01.ELX.0000463678.53334.c7. [DOI] [Google Scholar]
  • 15.Ahmed AMA, Temerk HA, Galal HR, Bazeed SES, Sultan S. The seropervelance of infectious hepatitis viruses (HBV, HCV and HEV) among blood donors and their correlation to risk factors in Qena governorate, Upper Egypt. VirusDisease [Internet] 2020;31(3):292–298. doi: 10.1007/s13337-020-00589-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Guy J, Peters MG. Liver disease in women: The influence of gender on epidemiology, natural history, and patient outcomes. Gastroenterol. Hepatol. 2013;9(10):633–639. [PMC free article] [PubMed] [Google Scholar]
  • 17.Saif-Al-Islam M, Mohamed HS, Younis MA, Abdelhamid MY, Ali MM, Khalaf S. Impact of gender difference on characteristics and outcome of chronic hepatitis C. Open J. Gastroenterol. 2020;10(11):281–294. doi: 10.4236/ojgas.2020.1011027. [DOI] [Google Scholar]
  • 18.Ruggieri A, Gagliardi MC, Anticoli S. Sex-dependent outcome of hepatitis B and C Viruses infections: Synergy of sex hormones and immune responses? Front. Immunol. 2018;9(OCT):1–7. doi: 10.3389/fimmu.2018.02302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Qureshi H, Arif A, Riaz K, Alam SE, Ahmed W, Mujeeb SA. Determination of risk factors for hepatitis B and C in male patients suffering from chronic hepatitis. BMC Res. Notes. 2009;2(1):1–6. doi: 10.1186/1756-0500-2-212. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Migliore L, Nicolì V, Stoccoro A. Gender specific differences in disease susceptibility: The role of epigenetics. Biomedicines. 2021;9(6):652. doi: 10.3390/biomedicines9060652. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Degenhardt L, Charlson F, Stanaway J, Larney S, Alexander LT, Hickman M, et al. Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: Findings from the Global Burden of Disease Study 2013. Lancet Infect. Dis. [Internet] 2016;16(12):1385–98. doi: 10.1016/S1473-3099(16)30325-5. [DOI] [PubMed] [Google Scholar]
  • 22.Le LVN, O’Connor S, Tran TH, Maher L, Kaldor J, Sabin K, et al. High hepatitis C virus infection among female sex workers in Viet Nam: strong correlation with HIV and injection drug use. West Pac. Surveill. Response J. WPSAR. 2019;10(3):9–18. doi: 10.5365/wpsar.2019.10.1.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Naguib GG, Farid A, Hassan M, Elshafie A, El Shazly Y, Shaker MK, et al. Direct-acting antiviral regimens in Egyptian patients with chronic hepatitis C virus infection: A real-world single-center experience. Arab. J. Gastroenterol. [Internet] 2021;22(4):285–291. doi: 10.1016/j.ajg.2021.06.001. [DOI] [PubMed] [Google Scholar]
  • 24.Sherief LM, Beshir MR, Salem GM, Sherbiny HS, Soliman AA, El-Komy MA, et al. Intrafamilial transmission of hepatitis C virus among families of infected pediatric oncology patients. Pediatr. Infect. Dis. J. 2019;38(7):692–697. doi: 10.1097/INF.0000000000002299. [DOI] [PubMed] [Google Scholar]
  • 25.Munn Z, MClinSc SM, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int. J. Evid. Based Healthc. 2015;13(3):147–153. doi: 10.1097/XEB.0000000000000054. [DOI] [PubMed] [Google Scholar]
  • 26.El-Faramawy AAM, El-Rashidy OF, Tawfik PH, Hussein GH. Transfusion transmitted hepatitis: Where do we stand now? A one center study in upper Egypt. Hepat. Mon. 2012;12(4):286. doi: 10.5812/hepatmon.852. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.El Garf A, El Zorkany B, Gheith R, Sheba H, Abdel Moneim G, El Garf K. Prevalence and clinical presentations of hepatitis C virus among patients admitted to the rheumatology ward. Rheumatol. Int. 2012;32(9):2691–2695. doi: 10.1007/s00296-011-2014-8. [DOI] [PubMed] [Google Scholar]
  • 28.Abdelwahab S, Rewisha E, Hashem M, Sobhy M, Galal I, Allam WR, et al. Risk factors for hepatitis C virus infection among Egyptian healthcare workers in a national liver diseases referral centre. Trans. R. Soc. Trop. Med. Hyg. 2012;106(2):98–103. doi: 10.1016/j.trstmh.2011.10.003. [DOI] [PubMed] [Google Scholar]
  • 29.Talaat M, Afifi S, Reaves EJ, Abu Elsood H, El-Gohary A, Refaey S, et al. Evidence of sustained reductions in the relative risk of acute hepatitis B and C virus infections, and the increasing burden of hepatitis a virus infection in Egypt: Comparison of sentinel acute viral hepatitis surveillance results, 2001–17. BMC Infect. Dis. 2019;19(1):1–13. doi: 10.1186/s12879-019-3806-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Sherief LM, Ragab SM, Helwa MA, Kamal NM, Afify MR, Mohammed RTS, et al. CMV, B and C hepatitis among multi-transfused hereditary hemolytic Anemia children: An updated Egyptian experience. Ital. J. Pediatr. 2021;47(1):1–12. doi: 10.1186/s13052-021-01072-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Dahab AA, Youssef MM, Eid HM, Elsadi KW. Reporting the undiagnosed cases of hepatitis B and hepatitis C viruses among patients undergoing elective eye surgery in a specialized eye hospital in Egypt. J. Ophthalmol. 2019 doi: 10.1155/2019/3985865. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Anwar WA, El Gaafary M, Girgis SA, Rafik M, Hussein WM, Sos D, et al. Hepatitis C virus infection and risk factors among patients and healthcare workers of Ain Shams University hospitals, Cairo, Egypt. PLoS ONE. 2021;16(2):e0246836. doi: 10.1371/journal.pone.0246836. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Abo-Amer YE-E, Abd-Elsalam S, Eldosoky H, ELShenawy AK, Awny S, Elagawy W, et al. Declining prevalence of hepatitis C virus among university students in one of the main governorates in Egypt. Infect. Drug Resist. 2018;11:2435. doi: 10.2147/IDR.S183462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Mohlman MK, Saleh DA, Ezzat S, Abdel-Hamid M, Korba B, Shetty K, et al. Viral transmission risk factors in an Egyptian population with high hepatitis C prevalence. BMC Public Health. 2015;15(1):1–6. doi: 10.1186/s12889-015-2369-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Mansour AK, Aly RM, Abdelrazek SY, Elghannam DM, Abdelaziz SM, Shahine DA, et al. Prevalence of HBV and HCV infection among multi-transfused Egyptian thalassemic patients. Hematol. Oncol. Stem Cell Ther. 2012;5(1):54–59. doi: 10.5144/1658-3876.2012.54. [DOI] [PubMed] [Google Scholar]
  • 36.El Feki MA, El Demellawy HH, Hifnawy T. Prevalence and risk factors of hepatitis C virus and its association with diabetes mellitus in rural versus urban districts in the Beni-Suef Governorate, Egypt. Egypt Liver J. 2013;3(2):28–34. doi: 10.1097/01.ELX.0000427104.13118.0e. [DOI] [Google Scholar]
  • 37.Barakat SH, El-Bashir N. Hepatitis C virus infection among healthy Egyptian children: Prevalence and risk factors. J. Viral Hepat. 2011;18(11):779–784. doi: 10.1111/j.1365-2893.2010.01381.x. [DOI] [PubMed] [Google Scholar]
  • 38.El-Wahab A, Ekram W, Abdel Maksoud A, Shatat HZ, Kotkat AM. Risky exposures and national estimate of HCV seroprevalence among school children in urban Egypt. VirusDisease. 2016;27(4):351–356. doi: 10.1007/s13337-016-0345-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Ibrahim I, Salah H, El Sayed H, Mansour H, Eissa A, Wood J, et al. Hepatitis C virus antibody titers associated with cognitive dysfunction in an asymptomatic community-based sample. J. Clin. Exp. Neuropsychol. 2016;38(8):861–868. doi: 10.1080/13803395.2016.1168780. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Aly Abd Elrazek AEM, Bilasy SE, Elbanna AEM, Elsherif AEA. Prior to the oral therapy, what do we know about HCV-4 in Egypt: A randomized survey of prevalence and risks using data mining computed analysis. Medicine (United States) 2014;93(28):e204. doi: 10.1097/MD.0000000000000204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.El Batae H, Amer I, Kobtan A, Saied SM, Ghazy A, Elkalla F, et al. Seroprevalence of hepatitis C virus among the newcomer students, Kafrelsheikh University, Egypt. J. Med. Virol. 2018;90(11):1745–1749. doi: 10.1002/jmv.25249. [DOI] [PubMed] [Google Scholar]
  • 42.Abdelmoemen G, Khodeir SA, Abou- Saif S, Kobtan A, Abd-Elsalam S. Prevalence of occult hepatitis C virus among hemodialysis patients in Tanta university hospitals: A single-center study. Environ. Sci. Pollut. Res. 2018;25(6):5459–5464. doi: 10.1007/s11356-017-0897-y. [DOI] [PubMed] [Google Scholar]
  • 43.Yousif MM, Fakhr AE, Morad EA, Kelani H, Hamed EF, Elsadek HM, et al. prevalence of occult hepatitis c virus infection in patients who achieved sustained virologic response to direct-acting antiviral agents. Infez. Med. 2018;26(3):237–243. [PubMed] [Google Scholar]
  • 44.Elhendawy M, Abo-Ali L, Abd-Elsalam S, Hagras MM, Kabbash I, Mansour L, et al. HCV and HEV: Two players in an Egyptian village, a study of prevalence, incidence, and co-infection. Environ. Sci. Pollut. Res. 2020;27(27):33659–33667. doi: 10.1007/s11356-020-09591-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.El-Akel W, El-Sayed MH, El Kassas M, El-Serafy M, Khairy M, Elsaeed K, et al. National treatment programme of hepatitis C in Egypt: Hepatitis C virus model of care. J. Viral Hepat. 2017;24(4):262–267. doi: 10.1111/jvh.12668. [DOI] [PubMed] [Google Scholar]
  • 46.Schmelzer J, Dugan E, Blach S, Coleman S, Cai Z, DePaola M, et al. Global prevalence of hepatitis C virus in children in 2018: A modelling study. Lancet Gastroenterol. Hepatol. [Internet] 2020;5(4):374–392. doi: 10.1016/S2468-1253(19)30385-1. [DOI] [PubMed] [Google Scholar]
  • 47.Abdel-Gawad M, Abd-elsalam S, Abdel-Gawad I, Tag-Adeen M, El-Sayed M, Abdel-Malek D. Seroprevalence of hepatitis C virus infection in children: A systematic review and meta-analysis. Liver Int. 2022;42:1241–1249. doi: 10.1111/liv.15212. [DOI] [PubMed] [Google Scholar]
  • 48.El-Zanaty F, Way A. Egypt Demographic and Health Survey 2008. Egyptian: Ministry of Health. El-Zanaty Assoc Macro International; 2009. [Google Scholar]
  • 49.Mohamoud YA, Mumtaz GR, Riome S, Miller DW, Abu-Raddad LJ. The epidemiology of hepatitis C virus in Egypt: A systematic review and data synthesis. BMC Infect. Dis. 2013;13(1):1–21. doi: 10.1186/1471-2334-13-288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.El-Adly A, Wardany A. Seroprevalence of hepatitis C virus among population in Luxor Governorate, Egypt. J. Hum. Virol. Retrovirol. 2017;5(2):2–6. [Google Scholar]
  • 51.Kandeel A, Genedy M, El-Refai S, Funk AL, Fontanet A, Talaat M. The prevalence of hepatitis C virus infection in Egypt 2015: Implications for future policy on prevention and treatment. Liver Int. 2017;37(1):45–53. doi: 10.1111/liv.13186. [DOI] [PMC free article] [PubMed] [Google Scholar]

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Supplementary Materials

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Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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