Abstract
Known for its high genetic diversity and variation in genotypic presence in different regions of the world, hepatitis C virus (HCV) is estimated to infect about 71 million people globally. Selection of an appropriate therapeutic regimen largely depends on the identification of the genotype responsible for the infection. This systematic review and meta-analysis was conducted to provide a comprehensive view of HCV genotype and subtype distribution in Southeast Asia (SEA). The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We searched five databases without year and language restrictions. Data from 90 eligible studies involving 15,089 genotypes and 9,646 subtypes representing 10 SEA countries were analyzed. The pooled estimates showed that genotype 1 (46.8%) [95% CI, 43.2–50.4; I2 = 92.77%; p < 0.001] was the most dominant HCV genotype in the region, followed by genotype 3 (23.1%) [95% CI, 19.4–27.2; I2 = 93.03%; p < 0.001], genotype 6 (16.5%) [95% CI, 13.8–19.6], genotype 2 (4.6%) [95% CI, 3.5–5.9], genotype 4 (1.1%) [95% CI, 0.7–1.5] and genotype 5 (0.8%) [95% CI, 0.4–1.3]. Philippines had the highest prevalence of genotypes 1 and 2. Genotype 6 became more prevalent after year 2000. Over 40 different subtypes were identified, with subtypes 1b (26.3%), 1a (21.3%), and 3a (14.3%) being the most prevalent of all the reported subtypes. Although on a global scale, genotype 6 is considered highly prevalent in SEA, evidence from this study reveals that it is the third most prevalent genotype within the region.
Highlights
Hepatitis C virus (HCV) infection constitutes a major health challenge globally
A total of 15,089 HCV genotypes were reported across the 90 studies and ranged from 6 to 3,020 (Table 1)
The pooled prevalence of genotype 1 (GT1) was estimated as 46.8% (Fig 2), genotype 2 (GT2) as 4.6%, genotype 3 (GT3) as 23.1%, genotype 4 (GT4) as 1.1%, genotype 5 (GT5) as 0.8%, and genotype 6 (GT6) as 16.5%
Summary
HCV exhibits an extraordinary sequence diversity, all genotypes possess identical complement of co-linear genes of similar size within the open reading frame (ORF), and the known variants contain considerably similar sequence across the genome [7] This makes it possible to classify them based on partial sequences from specific regions (e.g. core/E1 or NS5B) within the genome [7]. There has been no detailed report on the actual distribution of the virus’ genotypes in Southeast Asia (SEA)–a multiethnic and socioculturally diverse Asian region spanning Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam This is further compounded by the fact that newer variants of the virus are continually being identified and characterized. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) compliant review of published articles reporting HCV genotypes in SEA since the virus was first identified in 1989 to provide an in-depth and up-to-date information on the distribution of HCV genotypes in the region
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