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      Hepatitis C virus viremic rate in the Middle East and North Africa: Systematic synthesis, meta-analyses, and meta-regressions

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          Abstract

          Objectives

          To estimate hepatitis C virus (HCV) viremic rate, defined as the proportion of HCV chronically infected individuals out of all ever infected individuals, in the Middle East and North Africa (MENA).

          Methods

          Sources of data were systematically-gathered and standardized databases of the MENA HCV Epidemiology Synthesis Project. Meta-analyses were conducted using DerSimonian-Laird random-effects models to determine pooled HCV viremic rate by risk population or subpopulation, country/subregion, sex, and study sampling method. Random-effects meta-regressions were conducted to identify predictors of higher viremic rate.

          Results

          Analyses were conducted on 178 measures for HCV viremic rate among 19,593 HCV antibody positive individuals. In the MENA region, the overall pooled mean viremic rate was 67.6% (95% CI: 64.9–70.3%). Across risk populations, the pooled mean rate ranged between 57.4% (95% CI: 49.4–65.2%) in people who inject drugs, and 75.5% (95% CI: 61.0–87.6%) in populations with liver-related conditions. Across countries/subregions, the pooled mean rate ranged between 62.1% (95% CI: 50.0–72.7%) and 70.4% (95% CI: 65.5–75.1%). Similar pooled estimates were further observed by risk subpopulation, sex, and sampling method. None of the hypothesized population-level predictors of higher viremic rate were statistically significant.

          Conclusions

          Two-thirds of HCV antibody positive individuals in MENA are chronically infected. Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex. HCV viremic rate is a useful indicator to track the progress in (and coverage of) HCV treatment programs towards the set target of HCV elimination by 2030.

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          Most cited references132

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          Meta: An R Package for Meta-Analysis.

          G. Schwarzer, Schwarzer G (2007)
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            The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection.

            Jason Grebely, Kimberly Page, Rachel Sacks-Davis … (2014)
            Although 20%-40% of persons with acute hepatitis C virus (HCV) infection demonstrate spontaneous clearance, the time course and factors associated with clearance remain poorly understood. We investigated the time to spontaneous clearance and predictors among participants with acute HCV using Cox proportional hazards analyses. Data for this analysis were drawn from an international collaboration of nine prospective cohorts evaluating outcomes after acute HCV infection. Among 632 participants with acute HCV, 35% were female, 82% were Caucasian, 49% had interleukin-28 (IL28)B CC genotype (rs12979860), 96% had injected drugs ever, 47% were infected with HCV genotype 1, and 7% had human immunodeficiency virus (HIV) coinfection. Twenty-eight percent were HCV antibody negative/RNA positive at the time of acute HCV detection (early acute HCV). During follow-up, spontaneous clearance occurred in 173 of 632, and at 1 year after infection, 25% (95% confidence interval [CI]: 21, 29) had cleared virus. Among those with clearance, the median time to clearance was 16.5 weeks (IQR: 10.5, 33.4), with 34%, 67%, and 83% demonstrating clearance at 3, 6, and 12 months. Adjusting for age, factors independently associated with time to spontaneous clearance included female sex (adjusted hazards ratio [AHR]: 2.16; 95% CI: 1.48, 3.18), IL28B CC genotype (versus CT/TT; AHR, 2.26; 95% CI: 1.52, 3.34), and HCV genotype 1 (versus non-genotype 1; AHR: 1.56; 95% CI: 1.06, 2.30). The effect of IL28B genotype and HCV genotype on spontaneous clearance was greater among females, compared to males. Female sex, favorable IL28B genotype, and HCV genotype 1 are independent predictors of spontaneous clearance. Further research is required to elucidate the observed sex-based differences in HCV control. © 2013 by the American Association for the Study of Liver Diseases.
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              The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis

              Yousra Mohamoud, Ghina R. Mumtaz, Suzanne Riome … (2013)
              Background Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. Our study’s objective was to delineate the evidence on the epidemiology of HCV infection among the different population groups in Egypt, and to draw analytical inferences about the nature of HCV transmission in this country. Methods We conducted a systematic review of all data on HCV prevalence and incidence in Egypt following PRISMA guidelines. The main sources of data included PubMed and Embase databases. We also used a multivariate regression model to infer the temporal trend of HCV prevalence among the general population and high risk population in Egypt. Results We identified 150 relevant records, four of which were incidence studies. HCV incidence ranged from 0.8 to 6.8 per 1,000 person-years. Overall, HCV prevalence among pregnant women ranged between 5-15%, among blood donors between 5-25%, and among other general population groups between 0-40%. HCV prevalence among multi-transfused patients ranged between 10-55%, among dialysis patients between 50-90%, and among other high risk populations between 10% and 85%. HCV prevalence varied widely among other clinical populations and populations at intermediate risk. Risk factors appear to be parenteral anti-schistosomal therapy, injections, transfusions, and surgical procedures, among others. Results of our time trend analysis suggest that there is no evidence of a statistically significant decline in HCV prevalence over time in both the general population (p-value: 0.215) and high risk population (p-value: 0.426). Conclusions Egypt is confronted with an HCV disease burden of historical proportions that distinguishes this nation from others. A massive HCV epidemic at the national level must have occurred with substantial transmission still ongoing today. HCV prevention in Egypt must become a national priority. Policymakers, and public health and medical care stakeholders need to introduce and implement further prevention measures targeting the routes of HCV transmission.
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                Author and article information

                Contributors
                Manale Harfouche: Role: Formal analysisRole: Writing – original draft
                Hiam Chemaitelly: Role: Data curationRole: Formal analysis
                Silva P. Kouyoumjian: Role: Data curation
                Sarwat Mahmud: Role: Data curation
                Karima Chaabna: Role: Data curation
                Zaina Al-Kanaani: Role: Data curation
                Laith J. Abu-Raddad:
                ORCID: http://orcid.org/0000-0003-0790-0506
                Role: ConceptualizationRole: SupervisionRole: Writing – review & editing
                Ravi Jhaveri: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 31 October 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 10
                Electronic Location Identifier: e0187177
                Affiliations
                [1 ] Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
                [2 ] Department of Healthcare Policy & Research, Weill Cornell Medicine, Cornell University, New York, United States of America
                University of North Carolina at Chapel Hill School of Medicine, UNITED STATES
                Author notes

                Competing Interests: The authors have declared no competing interests exist.

                Author information
                http://orcid.org/0000-0003-0790-0506
                Article
                Publisher ID: PONE-D-17-28851
                DOI: 10.1371/journal.pone.0187177
                PMC ID: 5663443
                PubMed ID: 29088252
                SO-VID: 08ffeca1-0ce6-4a72-8426-b1516a802427
                Copyright © © 2017 Harfouche et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 7 August 2017
                Date accepted : 13 October 2017
                Page count
                Figures: 0, Tables: 5, Pages: 22
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100008982, Qatar National Research Fund;
                Award ID: NPRP-9-040-3-008
                Award Recipient :
                ORCID: http://orcid.org/0000-0003-0790-0506
                This publication was made possible by NPRP grant number 9-040-3-008 from the Qatar National Research Fund (a member of Qatar Foundation). The findings achieved herein are solely the responsibility of the authors. The authors are also grateful for infrastructure support provided by the Biostatistics, Epidemiology, and Biomathematics Research Core at Weill Cornell Medicine-Qatar.
                Categories
                Subject: Research Article
                Subject: Biology and life sciences
                Subject: Organisms
                Subject: Viruses
                Subject: RNA viruses
                Subject: Flaviviruses
                Subject: Hepacivirus
                Subject: Hepatitis C virus
                Subject: Biology and life sciences
                Subject: Microbiology
                Subject: Medical microbiology
                Subject: Microbial pathogens
                Subject: Viral pathogens
                Subject: Flaviviruses
                Subject: Hepacivirus
                Subject: Hepatitis C virus
                Subject: Medicine and health sciences
                Subject: Pathology and laboratory medicine
                Subject: Pathogens
                Subject: Microbial pathogens
                Subject: Viral pathogens
                Subject: Flaviviruses
                Subject: Hepacivirus
                Subject: Hepatitis C virus
                Subject: Biology and life sciences
                Subject: Organisms
                Subject: Viruses
                Subject: Viral pathogens
                Subject: Flaviviruses
                Subject: Hepacivirus
                Subject: Hepatitis C virus
                Subject: Biology and life sciences
                Subject: Microbiology
                Subject: Medical microbiology
                Subject: Microbial pathogens
                Subject: Viral pathogens
                Subject: Hepatitis viruses
                Subject: Hepatitis C virus
                Subject: Medicine and health sciences
                Subject: Pathology and laboratory medicine
                Subject: Pathogens
                Subject: Microbial pathogens
                Subject: Viral pathogens
                Subject: Hepatitis viruses
                Subject: Hepatitis C virus
                Subject: Biology and life sciences
                Subject: Organisms
                Subject: Viruses
                Subject: Viral pathogens
                Subject: Hepatitis viruses
                Subject: Hepatitis C virus
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Medicine and Health Sciences
                Subject: Nephrology
                Subject: Medical Dialysis
                Subject: Medicine and Health Sciences
                Subject: Hematology
                Subject: Hemoglobinopathies
                Subject: Thalassemia
                Subject: Medicine and Health Sciences
                Subject: Clinical Genetics
                Subject: Genetic Diseases
                Subject: Autosomal Recessive Diseases
                Subject: Thalassemia
                Subject: Research and Analysis Methods
                Subject: Mathematical and Statistical Techniques
                Subject: Statistical Methods
                Subject: Meta-Analysis
                Subject: Physical Sciences
                Subject: Mathematics
                Subject: Statistics (Mathematics)
                Subject: Statistical Methods
                Subject: Meta-Analysis
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Blood Donors
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: Egypt
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Africa
                Subject: Egypt
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

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