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

Sarwat Mahmud, Hiam S. Chemaitelly, Silva P. Kouyoumjian, Zaina Al Kanaani, Laith J. Abu-Raddad

Research output: Contribution to journalArticle


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.

Original languageEnglish
JournalJournal of Medical Virology
Publication statusAccepted/In press - 1 Jan 2019



  • genotype
  • HCV
  • meta-regression
  • Middle East and North Africa
  • transmission

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

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