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Global genotype distribution of hepatitis C viral infection among people who inject drugs.
Bielen R1,2, Robaeys G1,2,3, Azar DA2,3, Razavi H4, Nevens F3 1Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; 2Department of Gastro-Enterology and Hepatology, ZOL Genk, Belgium;
3Department of Gastro-Enterology and Hepatology, KULeuven, Belgium; 4Center for disease analysis, Louisville, USA
BACKGROUND AND OBJECTIVES
RESULTS
CONCLUSIONS
Hepatitis C viral infection (HCV) after injection drug use is very prevalent. The kind of genotype determines the response to treatment. Since People who inject drugs (PWID) are today the major risk group for HCV and to our knowledge no global systematic reviews on the worldwide genotype distribution of HCV genotypes in PWIDs have been published up to now, we conducted a systematic review on the global distribution of genotypes in PWIDs.
The most important genotype causing HCV infection in PWID globally is genotype 1, as is the case in the general population, but also genotype 3 is highly prevalent in PWID. Genotype 4 is most prevalent in Africa, spreading into Europe, whereas genotype 2 and 6 are more located in Asia. The most important difference comparing to the general population are generally lower prevalence of genotype 1b, and higher prevalence of genotype 3 in PWID. As the genotype nowadays still determines the treatment, and as there is a different genotype distribution than in the general population, it is important to identify the genotype also in PWID.
Figure 1:
Global distribution of HCV genotypes in the general population (outer rim) and PWID (inner circle). HCV prevalence in general population (central map) according to Gower et al2.
Figure 2:
Global distribution of HCV per genotype in PWID.
MATERIALS & METHODS
A systematic review was performed by using the keywords: Genotype, Hepatitis C, Injection drug user / Intravenous drug user / Substance user/ PWID, Name of countries in Pubmed, Embase and PsychInfo. The results were compared with the review of Gower et al. in 2014, concerning the distribution of HCV genotypes in the general HCV population. Data were graded according to the principles defined by Nelson et al in
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REFERENCES
Nelson PK, Mathers BM, Cowie B, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet 2011; 378(9791):
Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014; 61(1 Suppl): S45-57.
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ACKNOWLEDGEMENTS
132 studies in 48 countries (from 1995 to 2015) were collected. After grading these results, the data of 48 studies were used to determine the distribution of genotypes in PWID. Genotype 1 is the most prevalent genotype in PWID all over the world. In Europe, genotypes 1, 3 and 4 are highly prevalent. In North-South America and in Australia genotype 1 and 3 are most prevalent. In Asia genotype 2 and 6, and Africa genotype 1a and 4 are mostly observed. Overall, the most important differences comparing with the general population are a lower prevalence in the PWID population of genotype 1b and a higher prevalence of genotype 3.
We thank Mrs. Katie Razavi-Shearer for her contribution in creating figure 1. We thank Thomas Reyskens, Liesbeth Grondelaers and Carine Thaens for their contributions in creating figure 2. This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital.
Contact Information
Rob Bielen, PhD student Gastro-Enterology/Hepatology
/32,15,60 .