Abstract
The objective was to delineate hepatitis C virus (HCV) epidemiology in countries of Central Asia (CA), specifically Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. A systematic review was conducted guided by the Cochrane Collaboration Handbook, and reported using PRISMA guidelines. Meta-analyses were performed using DerSimonian-Laird random-effects models with inverse variance weighting. Random-effects meta-regression analyses were performed on general population studies. The systematic review identified a total of 208 HCV prevalence measures. No incidence or Turkmenistan studies were identified. Meta-analyses estimated HCV prevalence among the general population at 0.7% (95%CI: 0.7–0.8%) in Kazakhstan, 2.0% (95%CI: 1.7–2.4%) in Kyrgyzstan, 2.6% (95%CI: 1.7–3.6%) in Tajikistan, and 9.6 (95%CI: 5.8–14.2%) in Uzbekistan. Across CA, the pooled mean prevalence was 13.5% (95%CI: 10.9–16.4%) among non-specific clinical populations, 31.6% (95%CI: 25.8–37.7%) among populations with liver-related conditions, and 51.3% (95%CI: 46.9–55.6%) among people who inject drugs. Genotypes 1 (52.6%) and 3 (38.0%) were most frequent. Evidence was found for statistically-significant differences in prevalence by country, but not for a temporal decline in prevalence. CA is one of the most affected regions by HCV infection with Uzbekistan enduring one of the highest prevalence levels worldwide. Ongoing HCV transmission seems to be driven by injecting drug use and healthcare exposures.
Highlights
With approximately 71 million people chronically infected worldwide, hepatitis C virus (HCV) related morbidities place a strain on healthcare systems globally[1]
To our knowledge, the first systematic review and synthesis of HCV epidemiology in Central Asia (CA), a region perceived to be heavily affected by this infection[9,10]
Our results indicated that HCV antibody prevalence varies across countries of CA, ranging from 0.7% in Kazakhstan to 9.6% in Uzbekistan (Table 4 and Fig. S8)
Summary
With approximately 71 million people chronically infected worldwide, hepatitis C virus (HCV) related morbidities place a strain on healthcare systems globally[1]. Since the recent development of direct-acting antivirals (DAA), a breakthrough treatment which provides opportunities to reduce HCV infection and disease burden[2,3], the World Health Organization (WHO) has set a target for the elimination of HCV as a public health concern by 20304,5. An understanding of HCV epidemiology and risk factors for HCV infection worldwide is essential for developing targeted and cost-effective preventative and treatment interventions, to achieve the global target and eliminate HCV. Though the region is perceived to have one of the highest HCV prevalence levels worldwide[9,10], HCV epidemiology and the drivers of HCV transmission remain poorly characterized. Our objective was to delineate HCV epidemiology in CA by (1) performing a systematic review of all available records of HCV antibody incidence and/or antibody prevalence among the different population categories, (2) pooling all HCV antibody prevalence measures in the general population to estimate the country-specific population-level HCV prevalence, (3) estimating the number of HCV infected persons across countries of CA, (4) performing a secondary systematic review of all evidence on HCV genotype information, and (5) identifying sources of between-study heterogeneity and estimate their contribution to the variability in HCV prevalence among the general population
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