The epidemiology of hepatitis C virus in the fertile crescent

Systematic review and meta-analysis

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective: To characterize hepatitis C virus (HCV) epidemiology in countries of the Fertile Crescent region of the Middle East and North Africa (MENA), namely Iraq, Jordan, Lebanon, Palestine, and Syria. Methods: We systematically reviewed and synthesized available records of HCV incidence and prevalence following PRISMA guidelines. Meta-analyses were implemented using a DerSimo-nian-Laird random effects model with inverse weighting to estimate the country-specific HCV prevalence among the various at risk population groups. Results: We identified eight HCV incidence and 240 HCV prevalence measures in the Fertile Crescent. HCV sero-conversion risk among hemodialysis patients was 9.2% in Jordan and 40.3% in Iraq, and ranged between 0% and 3.5% among other populations in Iraq over different follow-up times. Our meta-analyses estimated HCV prevalence among the general population at 0.2% in Iraq (range: 0-7.2%; 95% CI: 0.1-0.3%), 0.3% in Jordan (range: 0-2.0%; 95% CI: 0.1-0.5%), 0.2% in Lebanon (range: 0-3.4%; 95% CI: 0.1-0.3%), 0.2% in Palestine (range: 0-9.0%; 95% CI: 0.2-0.3%), and 0.4% in Syria (range: 0.3-0.9%; 95% CI: 0.4-0.5%). Among populations at high risk, HCV prevalence was estimated at 19.5% in Iraq (range: 0-67.3%; 95% CI: 14.9-24.5%), 37.0% in Jordan (range: 21-59.5%; 95% CI: 29.3-45.0%), 14.5% in Lebanon (range: 0-52.8%; 95% CI: 5.6-26.5%), and 47.4% in Syria (range: 21.0-75.0%; 95% CI: 32.5-62.5%). Genotypes 4 and 1 appear to be the dominant circulating strains. Conclusions: HCV prevalence in the population at large appears to be below 1%, lower than that in other MENA sub-regions, and tending towards the lower end of the global range. However, there is evidence for ongoing HCV transmission within medical facilities and among people who inject drugs (PWID). Migration dynamics appear to have played a role in determining the circulating genotypes. HCV prevention efforts should be targeted, and focus on infection control in clinical settings and harm reduction among PWID.

Original languageEnglish
Article numbere0135281
JournalPLoS One
Volume10
Issue number8
DOIs
Publication statusPublished - 21 Aug 2015

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Epidemiology
Hepatitis C virus
systematic review
Viruses
meta-analysis
Hepacivirus
Meta-Analysis
epidemiology
Iraq
Jordan
Syria
Lebanon
Northern Africa
Eastern Africa
Middle East
medical facilities
Genotype
Population
Harm Reduction
incidence

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

The epidemiology of hepatitis C virus in the fertile crescent : Systematic review and meta-analysis. / Chemaitelly, Hiam; Chaabna, Karima; Aburaddad, Laith.

In: PLoS One, Vol. 10, No. 8, e0135281, 21.08.2015.

Research output: Contribution to journalArticle

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abstract = "Objective: To characterize hepatitis C virus (HCV) epidemiology in countries of the Fertile Crescent region of the Middle East and North Africa (MENA), namely Iraq, Jordan, Lebanon, Palestine, and Syria. Methods: We systematically reviewed and synthesized available records of HCV incidence and prevalence following PRISMA guidelines. Meta-analyses were implemented using a DerSimo-nian-Laird random effects model with inverse weighting to estimate the country-specific HCV prevalence among the various at risk population groups. Results: We identified eight HCV incidence and 240 HCV prevalence measures in the Fertile Crescent. HCV sero-conversion risk among hemodialysis patients was 9.2{\%} in Jordan and 40.3{\%} in Iraq, and ranged between 0{\%} and 3.5{\%} among other populations in Iraq over different follow-up times. Our meta-analyses estimated HCV prevalence among the general population at 0.2{\%} in Iraq (range: 0-7.2{\%}; 95{\%} CI: 0.1-0.3{\%}), 0.3{\%} in Jordan (range: 0-2.0{\%}; 95{\%} CI: 0.1-0.5{\%}), 0.2{\%} in Lebanon (range: 0-3.4{\%}; 95{\%} CI: 0.1-0.3{\%}), 0.2{\%} in Palestine (range: 0-9.0{\%}; 95{\%} CI: 0.2-0.3{\%}), and 0.4{\%} in Syria (range: 0.3-0.9{\%}; 95{\%} CI: 0.4-0.5{\%}). Among populations at high risk, HCV prevalence was estimated at 19.5{\%} in Iraq (range: 0-67.3{\%}; 95{\%} CI: 14.9-24.5{\%}), 37.0{\%} in Jordan (range: 21-59.5{\%}; 95{\%} CI: 29.3-45.0{\%}), 14.5{\%} in Lebanon (range: 0-52.8{\%}; 95{\%} CI: 5.6-26.5{\%}), and 47.4{\%} in Syria (range: 21.0-75.0{\%}; 95{\%} CI: 32.5-62.5{\%}). Genotypes 4 and 1 appear to be the dominant circulating strains. Conclusions: HCV prevalence in the population at large appears to be below 1{\%}, lower than that in other MENA sub-regions, and tending towards the lower end of the global range. However, there is evidence for ongoing HCV transmission within medical facilities and among people who inject drugs (PWID). Migration dynamics appear to have played a role in determining the circulating genotypes. HCV prevention efforts should be targeted, and focus on infection control in clinical settings and harm reduction among PWID.",
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