Hepatitis C Virus in the Middle East and North Africa

Abstract

This chapter presents the findings of the Middle East and North Africa (MENA) Hepatitis C Virus (HCV) Epidemiology Synthesis Project, the most comprehensive study on HCV epidemiology in this region to date. MENA is the region most affected by HCV worldwide. Two MENA countries, Egypt and Pakistan, are facing HCV epidemics of historic proportions. HCV prevalence in the rest of MENA is, however, comparable to global levels. About a third of a variety of clinical populations across countries have been exposed to HCV, with populations with high-risk healthcare exposures being particularly affected. Nearly half of people who inject drugs in MENA are also HCV infected. Substantial exposure to HCV infection has been further confirmed in populations with liver-related conditions. Medical care appears to be the primary source of past and current HCV exposures. Injecting drug use seems also to have played a role in the HCV epidemic, though relatively a much smaller role. Other modes of HCV transmission in MENA include mother-to-child transmission and community-related exposures. The molecular epidemiology of HCV in MENA indicated genotype 1 as ubiquitous in most countries. Genotype 3 (centered in Pakistan) and genotype 4 (centered in Egypt), however, account for most chronic HCV infections. Two-thirds of individuals ever exposed to HCV in MENA are chronically infected and in need of treatment. The scale-up of HCV treatment as prevention (TasP) is likely to yield immense and immediate reductions in HCV incidence and chronic infection prevalence, suggesting the feasibility of achieving the World Health Organization HCV elimination goal by 2030. HCV-TasP cost-effectiveness can be further optimized by prioritizing screening and testing for individuals at higher risk of exposure.