The epidemiology of hepatitis C virus in Pakistan: systematic review and meta-analyses

Abstract

To characterize hepatitis C virus (HCV) epidemiology in Pakistan and estimate the pooled mean HCV antibody prevalence in different risk populations, we systematically reviewed all available records of HCV incidence and/or prevalence from 1989 to 2016, as informed by the Cochrane Collaboration Handbook. This systematic review was reported following the PRISMA guidelines. Populations were classified into six categories based on the risk of exposure to HCV infection. Meta-analyses were performed using DerSimonian and Laird random-effects models with inverse variance weighting. The search identified one HCV incidence study and 341 prevalence measures/strata. Meta-analyses estimated the pooled mean HCV prevalence at 6.2% among the general population, 34.5% among high-risk clinical populations, 12.8% among populations at intermediate risk, 16.9% among special clinical populations, 55.9% among populations with liver-related conditions and 53.6% among people who inject drugs. Most reported risk factors in analytical epidemiologic studies related to healthcare procedures. Pakistan is enduring an HCV epidemic of historical proportions—one in every 20 Pakistanis is infected. HCV plays a major role in liver disease burden in this country, and HCV prevalence is high in all-risk populations. Most transmission appears to be driven by healthcare procedures. HCV treatment and prevention must become a national priority.

Epidemiology of hepatitis C virus among hemodialysis patients in the Middle East and North Africa: systematic syntheses, meta-analyses, and meta-regressions

“…Indeed, HCV prevalence among HD patients in MENA countries reflected in part HCV prevalence in the population at large in each country. For example, HCV prevalence among HD patients in Egypt and Pakistan was much higher than that in other MENA countries (Table 5), reflecting the higher prevalence in the wider population in these two countries [13,22].…”

“…The MENA HCV Epidemiology Synthesis Project database was compiled through systematic searches of the literature [13,[15][16][17][20][21][22] informed by the Cochrane Collaboration handbook [23] and reporting the findings using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [24]. The searched literature included international databases (PubMed and Embase), regional databases, national databases, and the MENA HIV/ AIDS Epidemiology Synthesis Project database [25,26], in addition to gray literature comprised of public health reports and routine data reporting, which are available from the authors upon request.…”

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

“…In this project, the MENA region consisted of 24 countries, as outlined in Supporting Box . As relevant in this study, separate analyses were conducted for Egypt and Pakistan, given the unique nature of the HCV epidemics in these two countries relative to the remaining MENA countries …”

“…P < 0.05 was considered to provide strong evidence for an association. HCV prevalence in the general population of each country was provided through meta‐analyses of prevalence in each MENA country . Statistical analyses were performed using STATA 13…”

“…Approximately 20% of all chronically infected individuals reside in the Middle East and North Africa (MENA) and mostly in the two countries most affected by HCV infection, Egypt and Pakistan . Direct‐acting antivirals (DAAs), a highly effective treatment that was recently developed, has provided the opportunity to control HCV transmission and its disease burden .…”