Hepatitis C Virus Infection in Persons Who Inject Drugs in the Middle East and North Africa: Intervention Strategies.

Jag H Khalsa,Poonam Mathur

doi:10.3390/v13071363

Abstract

There is a high incidence and prevalence of hepatitis C viral infection in persons with or without substance use disorders (SUDs) in the Middle East and North Africa (MENA) region, but only a small number receive comprehensive care. Highly effective direct-acting antiviral (DAA) medications are available at substantially lower costs; however, complete elimination of the hepatitis C virus (HCV) can only be achieved if integrated care strategies target those at highest risk for HCV infection and transmission and improve access to care. Due to the high prevalence of SUD in the MENA region, strategies to eliminate HCV must focus on integrated healthcare across multiple subspecialties, including addiction medicine, psychiatry, infectious diseases, hepatology, and social work. In this invited manuscript, we review the epidemiology of HCV in the MENA region and highlight intervention strategies to attain the WHO’s goal of HCV eradication by 2030.

Highlights

We review the epidemiology of Hepatitis C virus (HCV) in the Middle East and North Africa (MENA) region and highlight intervention strategies to attain the World Health Organization (WHO)’s goal of HCV eradication by 2030
people who inject drugs (PWIDs) in the MENA region, but only a small number receive comprehensive care aimed at HCV therapy and harm reduction
Cost-effective direct-acting antiviral (DAA) therapies are available in the MENA region

Summary

HCV Epidemiology in the MENA Region

The prevalence of viral hepatitis is generally higher in Middle Eastern countries than in Europe and the USA, possibly due to the migration of infected Asian persons [24]. In Pakistan, the HCV prevalence decreased from 6.7% in 2007–2008 [17] to 4.2% (7,001,000 cases) [27] in. The highest prevalence of HCV infection, not just in MENA, but in the world, is in Viruses 2021, 13, 1363. There is tremendous genotype diversity in the MENA region. Chronic HCV infections are highest among genotype 3, followed by genotypes 4, 1, and 2 [20]. Genotype 1 is dominant (≥50% of HCV infections) in Algeria, Iran, Morocco, Oman, Tunisia, and the UAE, but is distributed ubiquitously across the MENA region. Genotype 3 is the most common in Afghanistan and Pakistan, and genotype 4 is predominant in Egypt, Iraq, Jordan, Palestine, Qatar, Saudi Arabia, and Syria.

Risk Factors for HCV Transmission

Injection Drug Use and Substance Use Disorders in the MENA Region

Intervention Strategies for the MENA Region

Findings

Conclusions