Key associations for hepatitis C virus genotypes in the Middle East and North Africa.

Sarwat Mahmud; Hiam S Chemaitelly ORCID logo; Silva P Kouyoumjian; Zaina Al Kanaani; Laith J Abu-Raddad ORCID logo; (2019) Key associations for hepatitis C virus genotypes in the Middle East and North Africa. Journal of medical virology, 92 (3). pp. 386-393. ISSN 0146-6615 DOI: 10.1002/jmv.25614
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This study aimed to investigate the epidemiology of hepatitis C virus (HCV) genotypes in the Middle East and North Africa (MENA) through an analytical and quantitative meta-regression methodology. For the most common genotypes 1, 3, and 4, country/subregion explained more than 77% of the variation in the distribution of each genotype. Genotype 1 was common across MENA, and was more present in high-risk clinical populations than in the general population. Genotype 3 was much more present in Afghanistan, Iran, and Pakistan than the rest of countries, and was associated with transmission through injecting drug use. Genotype 4 was broadly disseminated in Egypt in all populations, with overall limited presence elsewhere. While genotype 2 was more present in high-risk clinical populations and people who inject drugs, most of the variation in its distribution remained unexplained. Genotypes 5, 6, and 7 had low or no presence in MENA, limiting the epidemiological inferences that could be drawn. To sum up, geography is the principal determinant of HCV genotype distribution. Genotype 1 is associated with transmission through high-risk clinical procedures, while genotype 3 is associated with injecting drug use. These findings demonstrate the power of such analytical approach, which if extended to other regions and globally, can yield relevant epidemiological inferences.


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