Characterization of the hepatitis C virus epidemic in Pakistan

Research output: Contribution to journalArticle

Abstract

Background: With one in every 20 Pakistanis already infected, Pakistan has the second largest number of hepatitis C virus (HCV) infections globally. The aim of this study was to present a quantitative and analytical characterization of the HCV epidemic in Pakistan. Methods: A standardized database of HCV antibody incidence and prevalence and HCV genotypes in all subpopulations was systematically assembled. Random-effects meta-analyses and random-effects meta-regressions were performed. Shannon Diversity Index was calculated to determine genotype diversity. Results: The database included two incidence, 309 prevalence, and 48 genotype measures. Pooled mean HCV prevalence ranged between 7.0% (95% confidence interval (CI): 5.8-8.3%) in Sindh and 0.9% (95% CI: 0.1-2.4%) in Federally Administered Tribal Areas (F.A.T.A). Estimated number of chronically-infected persons ranged between 4.2 million in Punjab and 0.03 million in F.A.T.A. HCV prevalence was stable over time [adjusted odds ratio (AOR) of 1.0 (95% CI: 1.0-1.0)]. Population classification was the strongest predictor of HCV prevalence, explaining 51.8% of prevalence variation. Relative to the general population, HCV prevalence was higher in people who inject drugs [AOR of 23.8 (95% CI: 13.0-43.6)], populations with liver-related conditions [AOR of 22.3 (95% CI: 15.7-31.6)], and high-risk clinical populations [AOR of 7.8 (95% CI: 4.8-12.7)]. Low genotype diversity was observed (Shannon diversity index of 0.67 out of 1.95; 34.5%). There were only minor differences in genotype diversity by province, with genotype 3 being most common in all provinces. Conclusion: Pakistan's HCV epidemic shows homogeneity across the provinces, and over time. HCV prevalence is strikingly persistent at high level, with no evidence for a decline over the last three decades. Scale up of HCV treatment and prevention is urgently needed.

Original languageEnglish
Article number809
JournalBMC Infectious Diseases
Volume19
Issue number1
DOIs
Publication statusPublished - 14 Sep 2019

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Pakistan
Hepacivirus
Genotype
Confidence Intervals
Odds Ratio
Population
Databases
Hepatitis C Antibodies
Incidence
Virus Diseases
Meta-Analysis
Liver

Keywords

  • Epidemic
  • Genotype
  • HCV
  • Hepatitis C
  • Pakistan
  • Prevalence
  • Province

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Characterization of the hepatitis C virus epidemic in Pakistan. / Mahmud, Sarwat; Al Kanaani, Zeinab; Aburaddad, Laith.

In: BMC Infectious Diseases, Vol. 19, No. 1, 809, 14.09.2019.

Research output: Contribution to journalArticle

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abstract = "Background: With one in every 20 Pakistanis already infected, Pakistan has the second largest number of hepatitis C virus (HCV) infections globally. The aim of this study was to present a quantitative and analytical characterization of the HCV epidemic in Pakistan. Methods: A standardized database of HCV antibody incidence and prevalence and HCV genotypes in all subpopulations was systematically assembled. Random-effects meta-analyses and random-effects meta-regressions were performed. Shannon Diversity Index was calculated to determine genotype diversity. Results: The database included two incidence, 309 prevalence, and 48 genotype measures. Pooled mean HCV prevalence ranged between 7.0{\%} (95{\%} confidence interval (CI): 5.8-8.3{\%}) in Sindh and 0.9{\%} (95{\%} CI: 0.1-2.4{\%}) in Federally Administered Tribal Areas (F.A.T.A). Estimated number of chronically-infected persons ranged between 4.2 million in Punjab and 0.03 million in F.A.T.A. HCV prevalence was stable over time [adjusted odds ratio (AOR) of 1.0 (95{\%} CI: 1.0-1.0)]. Population classification was the strongest predictor of HCV prevalence, explaining 51.8{\%} of prevalence variation. Relative to the general population, HCV prevalence was higher in people who inject drugs [AOR of 23.8 (95{\%} CI: 13.0-43.6)], populations with liver-related conditions [AOR of 22.3 (95{\%} CI: 15.7-31.6)], and high-risk clinical populations [AOR of 7.8 (95{\%} CI: 4.8-12.7)]. Low genotype diversity was observed (Shannon diversity index of 0.67 out of 1.95; 34.5{\%}). There were only minor differences in genotype diversity by province, with genotype 3 being most common in all provinces. Conclusion: Pakistan's HCV epidemic shows homogeneity across the provinces, and over time. HCV prevalence is strikingly persistent at high level, with no evidence for a decline over the last three decades. Scale up of HCV treatment and prevention is urgently needed.",
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AB - Background: With one in every 20 Pakistanis already infected, Pakistan has the second largest number of hepatitis C virus (HCV) infections globally. The aim of this study was to present a quantitative and analytical characterization of the HCV epidemic in Pakistan. Methods: A standardized database of HCV antibody incidence and prevalence and HCV genotypes in all subpopulations was systematically assembled. Random-effects meta-analyses and random-effects meta-regressions were performed. Shannon Diversity Index was calculated to determine genotype diversity. Results: The database included two incidence, 309 prevalence, and 48 genotype measures. Pooled mean HCV prevalence ranged between 7.0% (95% confidence interval (CI): 5.8-8.3%) in Sindh and 0.9% (95% CI: 0.1-2.4%) in Federally Administered Tribal Areas (F.A.T.A). Estimated number of chronically-infected persons ranged between 4.2 million in Punjab and 0.03 million in F.A.T.A. HCV prevalence was stable over time [adjusted odds ratio (AOR) of 1.0 (95% CI: 1.0-1.0)]. Population classification was the strongest predictor of HCV prevalence, explaining 51.8% of prevalence variation. Relative to the general population, HCV prevalence was higher in people who inject drugs [AOR of 23.8 (95% CI: 13.0-43.6)], populations with liver-related conditions [AOR of 22.3 (95% CI: 15.7-31.6)], and high-risk clinical populations [AOR of 7.8 (95% CI: 4.8-12.7)]. Low genotype diversity was observed (Shannon diversity index of 0.67 out of 1.95; 34.5%). There were only minor differences in genotype diversity by province, with genotype 3 being most common in all provinces. Conclusion: Pakistan's HCV epidemic shows homogeneity across the provinces, and over time. HCV prevalence is strikingly persistent at high level, with no evidence for a decline over the last three decades. Scale up of HCV treatment and prevention is urgently needed.

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