Hepatitis C Virus Infection in Populations With Liver‐Related Diseases in the Middle East and North Africa

Abstract

We investigated hepatitis C virus (HCV) epidemiology in populations with liver‐related diseases (LRDs) in the Middle East and North Africa. The data source was standardized databases of HCV measures populated through systematic reviews. Random‐effects meta‐analyses and meta‐regressions were performed, and genotype diversity was assessed. Analyses were based on 252 HCV antibody prevalence measures, eight viremic rate measures, and 30 genotype measures on 132,358 subjects. Pooled mean prevalence in LRD populations was 58.8% (95% confidence interval [CI], 51.5%‐66.0%) in Egypt and 55.8% (95% CI, 49.1%‐62.4%) in Pakistan; these values were higher than in other countries, which had a pooled prevalence of only 15.6% (95% CI, 12.4%‐19.0%). Mean prevalence was highest in patients with hepatocellular carcinoma at 56.9% (95% CI, 50.2%‐63.5%) and those with cirrhosis at 50.4% (95% CI, 40.8%‐60.0%). Type of LRD population and country were the strongest predictors of prevalence, explaining 48.6% of the variation. No evidence for prevalence decline was found, but there was strong evidence for prevalence increase in Pakistan. A strong, positive association was identified between prevalence in the general population and that in LRD populations; the Pearson correlation coefficient ranged between 0.605 and 0.862. The pooled mean viremic rate was 75.5% (95% CI, 61.0%‐87.6%). Genotype 4 was most common (44.2%), followed by genotype 3 (34.5%), genotype 1 (17.0%), genotype 2 (3.5%), genotype 6 (0.5%), and genotype 5 (0.3%). Conclusion: HCV appears to play a dominant role in liver diseases in Egypt and Pakistan and has a growing role in Pakistan. Testing and treatment of LRD populations are essential to reduce disease burden and transmission and to reach HCV elimination by 2030.

Hepatitis C risk score as a tool to identify infected individuals: A demonstration study in Egypt

“…For instance, province or city of birth and/or current residence, prior exposure to an HCV mode of transmission 22 , or history of HCV infection in the family, could be added, among others. Given that the risk of exposure to HCV infection varies immensely by at-risk subpopulation type and shows a distinctive hierarchy 23 , an additional component to the score could be to integrate the at-risk subpopulation type as a variable 23,24 , thereby further enhancing the diagnostic accuracy of the score. Testing strategies, therefore, could be highly efficient in identifying HCV infected persons at a modest cost.…”

Occult hepatitis C virus infection in the Middle East and Eastern Mediterranean countries: A systematic review and meta-analysis

“…A detailed analysis of HCV epidemiology in the Middle East found a pooled mean prevalence of 35.5% (95%CI: 31.7%-39.5%) in all patients with LDs; the highest rates were estimated for HCC (56.9%; 95%CI: 50.2%-63.5%) and hepatic cirrhosis (50.4%; 95%CI: 40.8%-60.0%). The pooled rate was 58.8% (95%CI: 51.5%-66.0%) in Egypt, 55.8% (95%CI: 49.1%-62.4%) in Pakistan, and 15.6% (95%CI: 12.4%-19.0%) in other countries[ 88 ]. The rate of HCV infection in each LD population of each country was strongly correlated with HCV prevalence among their GP.…”

“…The rate of HCV infection in each LD population of each country was strongly correlated with HCV prevalence among their GP. The authors concluded that their findings highlight how the role of this infection in liver diseases is a reflection of its background level in the GP[ 88 ]. Moreover, in countries like Egypt and Pakistan, high rates of infections among various populations with LDs may support the contribution of HCV to the occurrence of liver disease[ 9 , 10 ].…”

Occult hepatitis C infection: viruses with infectious potential in Huh7.5 and MDBK cell lines suggest HCV/OCI transmission

“…5 OCI has been described in patients with chronic liver disease, coinfections, comorbidities and in population with risk factors, such as, in patients infected with hepatitis B virus or human immunodeficiency virus, with tattoos, drugs users, and apparently in healthy population. [6][7][8][9][10][11] The primary goal of HCV therapy is to cure the infection, i.e. to achieve a sustained virological response (SVR) defined as undetectable HCV-RNA in serum after treatment completion, and the use of direct-acting antiviral agents (DAAs) markedly improved the SVR rates.…”