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Key associations for hepatitis C virus genotypes in the Middle East and North Africa
Sarwat Mahmud1, Hiam S Chemaitelly1, Silva P Kouyoumjian1
1Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.
Insights
Geography is the main factor influencing Hepatitis C Virus (HCV) genotype distribution in the Middle East and North Africa (MENA). Genotype 1 is linked to clinical procedures, while Genotype 3 is associated with injecting drug use.
Area of Science:
- Epidemiology
- Virology
- Public Health
Background:
- Hepatitis C Virus (HCV) poses a significant global health challenge.
- Understanding HCV genotype distribution is crucial for effective control strategies.
- The Middle East and North Africa (MENA) region presents unique epidemiological patterns for HCV.
Purpose of the Study:
- To investigate the epidemiology of Hepatitis C Virus (HCV) genotypes in the MENA region.
- To identify geographical and population-based determinants of HCV genotype distribution.
- To analyze the association between specific HCV genotypes and modes of transmission.
Main Methods:
- Analytical and quantitative meta-regression methodology.
- Analysis of country/subregion as explanatory variables for genotype distribution.
- Comparison of genotype prevalence across different populations (general vs. high-risk clinical).
Main Results:
- Country/subregion explained over 77% of the variation in genotypes 1, 3, and 4 distribution.
- Genotype 1 was prevalent across MENA, particularly in high-risk clinical groups.
- Genotype 3 showed higher prevalence in Afghanistan, Iran, and Pakistan, linked to injecting drug use.
- Genotype 4 was widespread in Egypt but limited elsewhere.
- Genotype 2 prevalence was higher in high-risk groups, with unexplained variations.
- Genotypes 5, 6, and 7 had minimal presence in the MENA region.
Conclusions:
- Geographical location is the primary determinant of HCV genotype distribution in MENA.
- HCV Genotype 1 is associated with transmission via high-risk clinical procedures.
- HCV Genotype 3 is strongly linked to transmission through injecting drug use.
- Meta-regression analysis provides powerful insights into epidemiological patterns.
Abstract:
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.
