Hepatitis C virus genotypes in the Middle East and North Africa: Distribution, diversity, and patterns

Abstract

Our objective was to characterize the distribution, diversity and patterns of hepatitis C virus (HCV) genotypes in the Middle East and North Africa (MENA). Source of data was a database of HCV genotype studies in MENA populated using a series of systematic literature searches. Pooled mean proportions were estimated for each genotype and by country using DerSimonian‐Laird random‐effects meta‐analyses. Genotype diversity within countries was assessed using Shannon Diversity Index. Number of chronic infections by genotype and country was calculated using the pooled proportions and country‐specific numbers of chronic infection. Analyses were conducted on 338 genotype studies including 82 257 genotyped individuals. Genotype 1 was dominant (≥50%) in Algeria, Iran, Morocco, Oman, Tunisia, and UAE, and was overall ubiquitous across the region. Genotype 2 was common (10‐50%) in Algeria, Bahrain, Libya, and Morocco. Genotype 3 was dominant in Afghanistan and Pakistan. Genotype 4 was dominant in Egypt, Iraq, Jordan, Palestine, Qatar, Saudi Arabia, and Syria. Genotypes 5, 6, and 7 had limited or no presence across countries. Genotype diversity varied immensely throughout MENA. Weighted by population size, MENA's chronic infections were highest among genotype 3, followed by genotype 4, genotype 1, genotype 2, genotype 5, and genotype 6. Despite ubiquitous presence of genotype 1, the vast majority of chronic infections were of genotypes 3 or 4, because of the sizable epidemics in Pakistan and Egypt. Three sub‐regional patterns were identified: genotype 3 pattern centered in Pakistan, genotype 4 pattern centered in Egypt, and genotype 1 pattern ubiquitous in most MENA countries.

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

“…[207]. For example, the dominant genotypes among HD patients in Egypt and Pakistan were genotypes 4 and 3, respectively (Table 6), similar to the dominant genotypes in the wider population in these two countries [207].…”

Characterization of demographics and NS5A genetic diversity for hepatitis C virus genotype 4‐infected patients with or without cirrhosis treated with ombitasvir/paritaprevir/ritonavir

“…High incidence of GT4 infection has been reported in the regions of Central, Eastern and Western sub‐Saharan Africa, where GT4 represents approximately 97%, 31% and 11% of the HCV‐infected patient population, respectively . In the regions of North Africa and the Middle East, GT4 has been reported to represent 65% of HCV infections; this includes the country of Egypt where 90% of HCV infections are caused by GT4 and around 15% of the general population is seropositive for HCV antibodies . Subtype distribution of GT4 also varies by country, with a high incidence of subtype 4a in Egypt, while subtypes 4a and 4d are common in Europe and more heterogeneous GT4 subtypes have been reported throughout Central and Eastern sub‐Saharan Africa …”

“…In the regions of North Africa and the Middle East, GT4 has been reported to represent 65% of HCV infections 3,4 ; this includes the country of Egypt where 90% of HCV infections are caused by GT4 and around 15% of the general population is seropositive for HCV antibodies. 1,5,6 Subtype distribution of GT4 also varies by country, with a high incidence of subtype 4a in Egypt, 5,7,8 while subtypes 4a and 4d are common in Europe 6,7,[9][10][11] and more heterogeneous GT4 subtypes have been reported throughout Central and Eastern sub-Saharan Africa.…”

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

“…The most common genotypes were genotype 4 (44%) and genotype 3 (35%), which reflect the major epidemics in Egypt and Pakistan, respectively. (42,45) The lack of evidence of a decline in prevalence over time with an increasing prevalence in Pakistan indicates that the recent introduction of DAA treatment has not yet demonstrated an impact on liver disease burden in the region. Evidence attributes the rapid growth of the epidemic in Pakistan to lower quality health care practices, such as insufficient blood screening, unnecessary therapeutic injections, and reuse of medical needles and syringes.…”