Hepatitis C genotype distribution and homology among geographically disparate injecting drug users in Afghanistan

Abstract

Hepatitis C virus (HCV) prevalence is high among injecting drug users in Afghanistan, but transmission dynamics are poorly understood. Samples from HCV-infected injecting drug users were sequenced to determine circulating genotypes and potential transmission linkages. Serum samples were obtained from injecting drug user participants in Hirat, Jalalabad, and Mazar-i-Sharif between 2006 and 2008 with reactive anti-HCV rapid tests. Specimens with detected HCV viremia were amplified and underwent sequence analysis. Of 113 samples evaluated, 25 samples (35.2%) were only typeable in NS5B, nine samples (12.7%) were only typeable in CE1, and 37 samples (52.1%) were genotyped in both regions. Of those with typeable HCV, all were Afghan males with a mean age of 31.1 (standard deviation [SD] ± 8.0) years and mean duration of injecting of 3.9 (SD ± 4.3) years. Most reported residence outside Afghanistan in the last decade (90.1%) and prior incarceration (76.8%). HCV genotypes detected were: 1a, (35.2%, n = 25), 3a (62.0%, n = 44), and 1b (2.8%, n = 2). Cluster formation was detected in NS5B and CE1 and were generally from within the same city. All participants within clusters reported being a refugee in Iran compared to 93.5% of those outside clusters. Only 22.2% (4/11) of those within clusters had been refugees in Pakistan and these four individuals had also been refugees in Iran. Predominance of genotype 3a and the association between HCV viremia and having been a refugee in Iran potentially reflects migration between Afghanistan and Iran among IDUs from Mazar-i-Sharif and Hirat and carry implications for harm reduction programs for this migratory population.

The epidemiology of hepatitis C virus in Afghanistan: systematic review and meta-analysis

“…Only one study was identified to this end and was among PWID. 55 The study reported dominance of genotype 3-a finding in line with the association between this genotype and injecting drug use globally. 77 The present systematic review and meta-analyses are limited by the quantity and quality of available studies, as well as their representativeness of the different at risk populations.…”

“…Only one study reported HCV genotype information among 71 HCV RNA positive PWID recruited from Herat, Mazar-i-Sharif, and Jalalabad between 2006 and 2008. 55 There were no individuals infected with multiple HCV genotypes. About two-thirds of participants (44 individuals) were infected with genotype 3a, while the rest were infected with genotype 1.…”

Distribution and Predominance of Genotype 3 in Hepatitis C Virus Carriers in the Province of Kahramanmaras, Turkey

“…Zhang et al ( 39 ) studied HCV-infected intravenous drug users in China and reported a prevalence rate of 47% for genotype 6 and 41% for genotype 3. Sanders-Buell et al ( 40 ) reported a prevalence rate of 62% for genotype 3 and 35% for genotype 1 among HCV-infected intravenous drug users in Afghanistan. The limitation of the present study was that urine drug tests were conducted on only 65 of the 313 patients.…”

Geographic Distribution of Hepatitis C Virus Genotypes in Pakistan

“…Predominance of genotype 3a was found in this study and previous studies from Pakistan ( 11 , 12 , 19 ). Genotype 3a has also been the predominant genotype in Afghanistan and India ( 20 , 21 ). Moreover, genotypes 1a and 1bwere common in Iran and China, respectively ( 18 , 22 ).…”