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Meta-Analysis
. 2018 Jan;90(1):131-141.
doi: 10.1002/jmv.24921. Epub 2017 Sep 12.

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

Sarwat Mahmud  1 , Zaina Al-Kanaani  1 , Hiam Chemaitelly  1 , Karima Chaabna  1   2 , Silva P Kouyoumjian  1 , Laith J Abu-Raddad  1   2
Affiliations
Meta-Analysis

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

Sarwat Mahmud et al. J Med Virol. 2018 Jan.

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.

Keywords: Hepatitis C virus; Middle East and North Africa; epidemiology; genotype; meta-analysis; transmission.

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Figures

Figure 1
Figure 1
The country‐specific distribution of hepatitis C virus (HCV) genotypes across the Middle East and North Africa (MENA) region. Legend: ‡ Countries in which less than three studies were available. Djibouti, Mauritania, Somalia, Sudan, and Yemen were excluded either due to no studies available or small sample size
Figure 2
Figure 2
Map of the dominant hepatitis C virus (HCV) genotype across countries of the Middle East and North Africa (MENA) region. Legend: Djibouti, Mauritania, Somalia, Sudan, and Yemen were excluded either due to no studies available or small sample size
Figure 3
Figure 3
Map showing the genotype diversity across countries of the Middle East and North Africa (MENA) region, quantified by Shannon Diversity Index. Legend: Djibouti, Mauritania, Somalia, Sudan, and Yemen were excluded either due to no studies available or small sample size
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