Three decades of change: schistosomiasis, hepatitis C, and the rise of metabolic dysfunction-associated steatotic liver disease in Egypt.

Chronic liver disease (CLD) profile in Egypt has shifted dramatically over three decades: schistosomiasis dominated through the 1980s, hepatitis C virus (HCV) became the principal cause from the 1990s-2010s, and metabolic dysfunction-associated steatotic liver disease (MASLD) is now rising as viral hepatitis recedes. Drawing on national surveys and programmatic data, this editorial clarifies the timeline and drivers of that transition and translates them into policy. Schistosomiasis declined with praziquantel-based control, while iatrogenic transmission during mid 20th-century parenteral antischistosomal therapy fueled an unparalleled HCV epidemic; by 2008, anti-HCV prevalence reached 14.7% among adults aged 15-59 years with roughly one in ten chronically infected. Egypt established a coordinated HCV program in 2006 and, from 2014, rapidly scaled direct-acting antivirals alongside nationwide testing and standardized care pathways. In 2018-2019, the "100 Million Healthy Lives" campaign screened 57 million citizens and treated about 4 million, contributing the largest single-country share of global HCV cures and earning WHO validation of progress toward elimination. As HCV wanes, MASLD has emerged within a population carrying heavy burdens of obesity and diabetes; national screening recorded anthropometrics for around 50 million adults, with 39.84% meeting obesity criteria (women 49.51%, men 29.53%) and nearly three-quarters overweight or obese when projected to 2022 population counts. Priorities now are to consolidate HCV gains-targeted testing, micro-elimination, and post-SVR risk-stratified HCC surveillance-while building integrated primary-care MASLD pathways using simple non-invasive fibrosis triage, staged referrals, and pragmatic, equitable coverage. With its HCV-era infrastructure, Egypt is positioned to lead a standardized, regionally scalable response to MASLD.