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Habib A, Habib N, Anjum KM, Iqbal R, Ashraf Z, Taj MU, Asim M, Javid K, Idoon F, Dashti S, Medeiros CR, Gurgel APAD, Coutinho HDM. Molecular evolution, virology and spatial distribution of HCV genotypes in Pakistan: A meta-analysis. INFECTIOUS MEDICINE 2023; 2:324-333. [PMID: 38205178 PMCID: PMC10774773 DOI: 10.1016/j.imj.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 01/12/2024]
Abstract
Background Hepatitis C, caused by the Hepatitis C Virus (HCV), is the second most common form of viral hepatitis. The geographical distribution of HCV genotypes can be quite complex, making it challenging to ascertain the most prevalent genotype in a specific area. Methods To address this, a review was conducted to determine the prevalence of HCV genotypes across various provinces and as a whole in Pakistan. The scientific literature regarding the prevalence, distribution, genotyping, and epidemiology of HCV was gathered from published articles spanning the years 1996-2020. Results Genotype 1 accounted for 5.1% of the patients, with its predominant subtype being 1a at 4.38%. The frequencies of its other subtypes, 1b and 1c, were observed to be 1.0% and 0.31% respectively. Genotype 2 had a frequency of 2.66%, with the most widely distributed subtype being 2a at 2.11% of the patients. Its other subtypes, 2b and 2c, had frequencies of 0.17% and 0.36% respectively. The most prevalent genotype among all isolates was 3 (65.35%), with the most frequent subtype being 3a (55.15%), followed by 3b (7.18%). The prevalence of genotypes 4, 5, and 6 were scarce in Pakistan, with frequencies of 0.97%, 0.08%, and 0.32% respectively. The prevalence of untypeable and mixed genotypes was 21.34% and 3.53% respectively. Estimating genotypes proves to be a productive method in assisting with the duration and selection of antiviral treatment. Different HCV genotypes can exhibit variations in their response to specific antiviral treatments. Different genotypes may have distinct natural histories, including variations in disease progression and severity. Some genotypes may lead to more rapid liver damage, while others progress more slowly. Conclusions This information can guide screening and testing strategies, helping to identify individuals at higher risk of developing severe complications. Studying the distribution of HCV genotypes in a population can provide valuable insights into the transmission dynamics of the virus.
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Affiliation(s)
- Arslan Habib
- Laboratory of Molecular Immunology, School of Life Sciences, Fudan University, Shanghai 200433, China
| | - Nadiya Habib
- Department of Zoology, University of Gujrat, Gujrat, Punjab 50700, Pakistan
| | - Khalid Mahmood Anjum
- Department of Zoology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Riffat Iqbal
- Department of Zoology, Government College University, Lahore 54000, Pakistan
| | - Zeeshan Ashraf
- Department of Fisheries and Aquaculture, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Muhammad Usman Taj
- Department of Fisheries and Aquaculture, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Muhammad Asim
- Department of Zoology, University of Narowal, Narowal 51600, Pakistan
| | - Kanwal Javid
- Department of Geography, Government College University, Lahore 54000, Pakistan
| | - Faezeh Idoon
- Department of Surgical Technology, Ferdows School of Allied Medicine and Public Health, Birjand University of Medical Sciences, Birjand 97178, Iran
| | - Saeid Dashti
- Ferdows School of Paramedical and Health, Birjand University of Medical Sciences, Birjand 97178, Iran
| | | | | | - Henrique Douglas Melo Coutinho
- Laboratory of Microbiology and Molecular Biology (LMBM), Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil
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Khan S, Alam M, Rauf Z, Noreen R, Shah K, Khan A, Ozdemir B, Selamoglu Z. Comparison of Biochemical Parameters in Patients with Hepatitis B, C, and Dual Hepatitis B and C in Northwest Pakistan. ARCHIVES OF RAZI INSTITUTE 2022; 77:869-879. [PMID: 36284958 PMCID: PMC9548253 DOI: 10.22092/ari.2022.357172.1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/26/2022] [Indexed: 05/24/2023]
Abstract
The leading causes of hepatitis are viral infections, Hepatitis B virus (HBV) and Hepatitis C virus (HCV). Millions of people have been infected with these deadly viral infections worldwide, and in Pakistan, every tenth person is infected with these viruses. Different populations respond with different rates to infectious diseases due to host genomic differences. To evaluate and compare the biochemical parameters in different types of hepatitis (Hepatitis B, C, and Co-infection) and different ethnic groups, a total of 200 pre-screened patients were recruited from District Headquarters Teaching Hospital Dera Ismail Khan and Tank. Blood samples (5ml) were taken from patients and were assayed for biochemical parameters, including four liver function tests (LFTs) and two renal function tests (RFTs). In 200 patients, the mean scores of Alanine transaminase (ALT) were 376±335, 315±265, and 478±519 IU/L in HBV, HCV, and co-infected patients, respectively. Moreover, the mean score of ALT was 31±7.2 IU/l in the normal control group. All other biochemical parameters demonstrated elevated levels in co-infection, HBV, and HCV, respectively, except total proteins. The RFTs showed a threshold or upper normal limit (UNL); nonetheless, when compared to normal control subjects, RFTs parameters were high in infected patients, as compared to normal control. Ethnicity wise comparison of parameters indicated that Pushtoon ethnic group indicated a high degree of severity of HBV infection and co-infection, as compared to Saraiki and Rajpoot ethnic groups, while Saraiki ethnic group showed a higher severity of HCV than both of Pushtoon and Rajpoot. Rajpoot ethnic group was least affected than both Pushtoon and Saraiki ethnic groups. Co-infected patients were more severely affected, as compared to HBV and HCV patients. The ethnicity-wise study provided evidence that different ethnic groups showed different degrees of severity. There may be some genetic background involved in hepatitis B and C viral infection due to which all three ethnic groups showed different degrees of severity. In gender-wise comparisons, male patients were more affected than female patients.
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Affiliation(s)
- S Khan
- Institute of Molecular Biology and Biotechnology, University of Lahore, 1-KM Defense Road Lahore-54000, Pakistan
| | - M Alam
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan-29050. KPK, Pakistan
| | - Z Rauf
- Department of Statistics, (INS) Gomal University, Dera Ismail Khan-29050, KPK, Pakistan
| | - R Noreen
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan-29050. KPK, Pakistan
| | - K Shah
- Department of Pharmaceutics, Faculty of Pharmacy, Gomal University, Dera Ismail Khan-29050, KPK, Pakistan
| | - A Khan
- Department of Sports Sciences and Physical Education, University of the Punjab, Lahore-54000, Pakistan
| | - B Ozdemir
- Department of Cardiology Faculty of Medicine, Nigde Omer Halisdemir University, Campus, 51240, Nigde, Turkey
| | - Z Selamoglu
- Department of Medical Biology, Faculty of Medicine, Nigde Ömer Halisdemir University, Nigde, Turkey
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Saboor Soomro R, Shah IA, Saboor A, Bhutto AUB, Memon S. Sensitivity and Specificity of Hepatitis B Virus Screening via Rapid Immunoassay Chromatographic Test. Cureus 2021; 13:e12909. [PMID: 33654594 PMCID: PMC7906272 DOI: 10.7759/cureus.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: In low-income and high hepatitis B and C virus burden countries like Pakistan, it is important to develop cheap yet efficient strategies in diagnosing as well as treating hepatitis. The aim of this study is to assess the sensitivity and specificity of serum hepatitis B surface antigen (HbsAg) via Rapid Immunoassay Chromatographic Test (RICT) for the screening of hepatitis B, compared to the gold standard laboratory-based method. Methods: The study was conducted in the Hepatology Clinic of Civil Hospital, Sukkur. All records of the clinic from June 1, 2018, to December 31, 2018, were accessed for identification of the records in which hepatitis B screening via RICT and then confirmatory polymerase chair reaction (PCR) by gene amplification with forward and reverse primers was done. Results: There were 151 samples in this study. There were 32 (94.1%) true-positive and three (5.8%) false-negative samples. There were two (2.5%) false-positive and 114 (97.4%) true-negative samples. The sensitivity of HbsAg detection via RICT for the screening of 1-1B V was 91.43%, specificity was 98.28% and the accuracy was 96.69%, compared to PCR. Conclusion: The RICT method has high sensitivity and specificity. In low-income and high-hepatitis B virus-burden countries like Pakistan, it serves as a very efficient screening tool that is easy to use, cheaper in cost, and gives rapid and accurate results.
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Affiliation(s)
| | - Iftikhar Ali Shah
- Internal Medicine, Ghulam Muhammad Mahar Medical College Hospital, Sukkur, PAK
| | - Abdul Saboor
- Urology, Ghulam Muhammad Mahar Medical College Hospital, Sukkur, PAK
| | | | - Sidra Memon
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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Iftikhar S, Akhtar M. Variability in the immunogenic preS region of Pakistani hepatitis B virus isolates. Virusdisease 2019; 30:329-335. [PMID: 31803798 DOI: 10.1007/s13337-019-00518-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/13/2019] [Indexed: 11/25/2022] Open
Abstract
This paper reports the genetic variability of hepatitis B virus in Pakistan population. The worldwide prevalence of hepatitis B virus is estimated to be around 350 million that causes significant mortality especially in developing countries like Pakistan. In this study, genetic diversity of HBV was checked by using preS domain of HBV. About seventy-five samples were selected for study. Among these samples nine samples showed positive results after PCR and gel analysis. These nine samples were named SBS001-SBS008. After gel purification these samples were ligated in T/A cloning vector and transformed with E. coli DH5α. After successful cloning and positive restriction analysis these samples were subjected to DNA sequencing. Sequencing results showed that eight samples (SBS002-SBS008) have a deletion of 33 nucleotides at N-terminal that is characteristics of genotype D while SBS001 belongs to genotype C. Silent mutations and amino acid changes were also searched in this highly variable region of genome. Based upon this study it was concluded that genotype D is the most common genotype in Pakistan.
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Affiliation(s)
- Saima Iftikhar
- School of Biological Sciences, Quid-e-Azam Campus, Punjab University, Lahore, Pakistan
| | - Muhammad Akhtar
- School of Biological Sciences, Quid-e-Azam Campus, Punjab University, Lahore, Pakistan
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Rafiq A, Fatima S, Masood B, Khan RA, Khan FA, Liaquat A, Fatima A, Tanveer MS, Sulaiman M, Hasan SY, Aehtesham M, Khan S. Awareness of hepatitis B and C among students of nonmedical universities in Karachi. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0902.381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Pakistan is highly endemic with hepatitis B virus (HBV) and the incidence of HBV infection is rising steadily. The reasons may include poor public awareness about the transmission of HBV and HCV.
Objectives
To assess the awareness of HBV and HCV among students in nonmedical universities.
Methods
The study instrument was a structured 36 item questionnaire. After obtaining permission from the respective administrations, students were approached within their university campuses and were included by convenience sampling. The results were expressed as frequencies.
Results
Five hundred students from 5 different institutions participated in the survey, with 100 students representing each institute. Most students did not recognize the possible modes of infection of hepatitis B that include reuse of syringes (57.2%), blood transfusions (62.6%), and sexual contact (57.4%). However, most (67.8%) students correctly believe that there is a vaccination available for the prevention of HBV. Most students did not recognize the possible modes of infection of hepatitis C that include reuse of syringes (61.8%), use of intravenous drugs of addiction (71.4%), sexual contact (55.6%), and blood transfusions (55.2%) as possible modes of transmission. Most students (51.8%) incorrectly believed that there is a vaccination available for the prevention of HCV.
Conclusions
There is a prominent lack of awareness regarding the risk factors for HBV and HCV infection among the student community of nonmedical universities in Karachi, and an immediate need to conduct nationwide awareness programs to raise the awareness of HBV and HCV transmission in the Pakistani population exists.
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Affiliation(s)
- Ali Rafiq
- Dow University of Health Sciences , Karachi 74200 , Pakistan
| | - Saba Fatima
- Dow University of Health Sciences , Karachi 74200 , Pakistan
| | - Beenish Masood
- Dow University of Health Sciences , Karachi 74200 , Pakistan
| | | | | | - Aimen Liaquat
- Dow University of Health Sciences , Karachi 74200 , Pakistan
| | - Aelia Fatima
- Dow University of Health Sciences , Karachi 74200 , Pakistan
| | | | | | | | | | - Sidra Khan
- Dow University of Health Sciences , Karachi 74200 , Pakistan
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Mahmood M, Anwar MA, Khanum A, Zaman N, Raza A. Distribution and clinical significance of hepatitis B virus genotypes in Pakistan. BMC Gastroenterol 2016; 16:104. [PMID: 27565427 PMCID: PMC5002161 DOI: 10.1186/s12876-016-0513-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 02/07/2023] Open
Abstract
Background Hepatitis B virus (HBV) genotype and its role in disease progression and patients’ response to antiviral treatment, is not well studied in Pakistan. This comprehensive study was aimed to determine the distribution of HBV genotypes in Pakistan and their possible association with phases of HBV infection. Methods A total of 840 HBsAg positive samples was collected and tested for HBV DNA quantity. Samples below 100 IU/ml were excluded from the study. A total of 715 samples representing all the six parts of the country were genotyped by type specific primer PCR method. Clinical data of only 384 patients was compared as the remaining 332 were either receiving antiviral treatment or their infection phase was not confirmed. Results Genotype D was found in 509 samples (71.2 %), genotype A in 55 samples (7.7 %) and mixed infection with genotypes A and D in 124 samples (17.3 %). Genotypes B, C and E were identified in less than 1 % of the total samples. Genotype A, D and their mixture (A + D) were compared for severity of HBV infection. Significant differences were not found in distribution of HBV genotypes among different disease stages. Conclusion HBV genotype D was the predominant infection in all study areas of Pakistan followed by mixed genotypes infection (A + D) whereas genotype A has 10 times lower prevalence than genotype D. Genotypes B, C, E and F altogether make only 1.5 % of the prevalence. Genotype do not appears to show the severity of liver disease.
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Affiliation(s)
- Majid Mahmood
- Department of Zoology, The University of Poonch, Rawalakot, Azad Jammu and Kashmir, 12350, Pakistan. .,Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, 46300, Pakistan.
| | - Muhammad Asim Anwar
- Department of General Medicine, Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad, 44000, Pakistan
| | - Azra Khanum
- Barani Institute of Management Sciences (BIMS), Rawalpindi, 46300, Pakistan
| | - Nasib Zaman
- Center for Biotechnology & Microbiology, University of Swat, Swat, 19130, Pakistan
| | - Abida Raza
- Diagnostic Department, Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, 44000, Pakistan
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Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepatogastroenterol 2016; 6:70-81. [PMID: 29201731 PMCID: PMC5578565 DOI: 10.5005/jp-journals-10018-1172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 11/29/2015] [Indexed: 12/17/2022] Open
Abstract
Viral hepatitis is a major cause of morbidity and mortality worldwide and a rising cause for concern in Asian countries. Weather it is blood borne or water/food borne hepatotropic virus, increasing burden is alarming for Asian countries. In this review we have evaluated the existing data to estimate the burden of viral hepatitis in populations of all age groups nationwide, along with an assessment of the risk factors and preventive and management strategies currently employed in Pakistan. The aim of our work is to consolidate and supplement the present knowledge regarding viral hepatitis in light of past and present trends and to provide future direction to the existing health policies. How to cite this article Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepato-Gastroenterol 2016;6(1):70-81.
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Affiliation(s)
- Amna Subhan Butt
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Fatima Sharif
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Sadeghi F, Salehi-Vaziri M, Almasi-Hashiani A, Gholami-Fesharaki M, Pakzad R, Alavian SM. Prevalence of Hepatitis C Virus Genotypes Among Patients in Countries of the Eastern Mediterranean Regional Office of WHO (EMRO): A Systematic Review and Meta-Analysis. HEPATITIS MONTHLY 2016; 16:e35558. [PMID: 27274353 PMCID: PMC4894080 DOI: 10.5812/hepatmon.35558] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/26/2016] [Accepted: 02/05/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT Hepatitis C virus (HCV) infection is a major global public health issue. The Eastern Mediterranean regional office (EMRO) of the world health organization (WHO) seems to have one of the highest prevalence rates worldwide, with at least 21.3 million HCV-infected patients. OBJECTIVES The aim of the present study was to review systematically all epidemiological data related to the prevalence of HCV genotypes in infected patients in EMRO countries. DATA SOURCES A systematic search was conducted of peer-reviewed journals indexed in electronic databases (PubMed, Scopus, ISI, PakMediNet, and IMEMR, and Persian-specific databases including SID, Iran Medex, and MagIran). STUDY SELECTION A systematic search was performed with temporal limits (papers published between January 2000 up to June 2015), regarding the prevalence and distribution of HCV genotypes in EMRO countries. DATA EXTRACTION The prevalence rates of HCV genotypes were pooled by metan command in Stata 14. Statistical heterogeneity was explored using the I-square at the 5% significance level. Publication bias was assessed, graphically and statistically, by funnel plot and Begg and Egger tests. RESULTS A total of 563 records were identified through the electronic search. Of these records, 134 studies comprising 67681 HCV-infected individuals were included in the meta-analysis. In Iran, subtype 1a was the predominant subtype with a rate of 42% (95% CI, 39 - 46), followed by subtype 3a, 35% (95% CI, 31 - 38). In Pakistan, Subtype 3a was the most common subtype with a rate of 56% (95% CI, 49 - 62), followed by subtype 3b, 10% (95% CI, 7 - 12). In Saudi Arabia and Egypt, genotype 4 was the most prevalent genotype with a rate of 65% (95% CI, 59 - 72) and 69% (95% CI, 36 - 100) respectively. In Tunisia and Morocco, subtype 1b was the most common subtype with a rate of 69% (95% CI, 50 - 88) and 32% (95% CI, 7 - 56) respectively. CONCLUSIONS The genotype distribution of HCV takes diverse patterns in EMRO countries. Genotypes 1 and 3 were predominant in Iran and Pakistan, while genotype 4 and 1 were the most common genotypes in the Middle East Arab countries and North African Arab countries. Understanding the genotypes of HCV can help policy makers in designing good strategies for treatment.
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Affiliation(s)
- Farzin Sadeghi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran
| | - Mostafa Salehi-Vaziri
- Department of Arboviruses and Viral Hemorrhagic Fevers, Institute Pasteur of Iran, Tehran, IR Iran
| | - Amir Almasi-Hashiani
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Reza Pakzad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Seyed Moayed Alavian, Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran, E-mail:
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Umer M, Iqbal M. Hepatitis C virus prevalence and genotype distribution in Pakistan: Comprehensive review of recent data. World J Gastroenterol 2016; 22:1684-1700. [PMID: 26819533 PMCID: PMC4721999 DOI: 10.3748/wjg.v22.i4.1684] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/11/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is endemic in Pakistan and its burden is expected to increase in coming decades owing mainly to widespread use of unsafe medical procedures. The prevalence of HCV in Pakistan has previously been reviewed. However, the literature search conducted here revealed that at least 86 relevant studies have been produced since the publication of these systematic reviews. A revised updated analysis was therefore needed in order to integrate the fresh data. A systematic review of data published between 2010 and 2015 showed that HCV seroprevalence among the general adult Pakistani population is 6.8%, while active HCV infection was found in approximately 6% of the population. Studies included in this review have also shown extremely high HCV prevalence in rural and underdeveloped peri-urban areas (up to 25%), highlighting the need for an increased focus on this previously neglected socioeconomic stratum of the population. While a 2.45% seroprevalence among blood donors demands immediate measures to curtail the risk of transfusion transmitted HCV, a very high prevalence in patients attending hospitals with various non-liver disease related complaints (up to 30%) suggests a rise in the incidence of nosocomial HCV spread. HCV genotype 3a continues to be the most prevalent subtype infecting people in Pakistan (61.3%). However, recent years have witnessed an increase in the frequency of subtype 2a in certain geographical sub-regions within Pakistan. In Khyber Pakhtunkhwa and Sindh provinces, 2a was the second most prevalent genotype (17.3% and 11.3% respectively). While the changing frequency distribution of various genotypes demands an increased emphasis on research for novel therapeutic regimens, evidence of high nosocomial transmission calls for immediate measures aimed at ensuring safe medical practices.
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Saeed U, Waheed Y, Ashraf M, Waheed U, Anjum S, Afzal MS. Estimation of Hepatitis B Virus, Hepatitis C Virus, and Different Clinical Parameters in the Thalassemic Population of Capital Twin Cities of Pakistan. Virology (Auckl) 2015; 6:11-6. [PMID: 26568681 PMCID: PMC4636113 DOI: 10.4137/vrt.s31744] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 02/07/2023] Open
Abstract
Hepatitis B and C are serious public health problems worldwide. Thalassemia patients are dependent on blood transfusions throughout their life and are at high risk of viral infections. The aim of this study was to estimate the prevalence of hepatitis B/C infections and different clinical parameters in multitransfused thalassemia population. In this study, 262 multitransfused β-thalassemia patients were enrolled from the capital twin cities of Pakistan. The presence of hepatitis B virus (HBV)/hepatitis C virus (HCV), alanine aminotransferase (ALT) level, serum creatinine, serum ferritin, hepatomegaly, splenomegaly, and splenectomy were analyzed. The overall prevalence of HBV and HCV was 3.08% and 55.73%, respectively, with 100% of patients older than 20 years had HCV infection. The ALT levels among HBV- and HCV-positive thalassemia patients were 92.62 ± 41.57 U/L and 98 ± 63.65 U/L, respectively; creatinine values observed were 0.4 ± 0.35 mg/dL (for HBV) and 0.39 ± 0.24 mg/dL (for HCV), while serum ferritin levels were 6865.87 ± 1649.13 ng/dL (for HBV) and 5445.95 ± 3059.28 ng/dL (for HCV). A total of 74.8% and 82.20% of HBV- and HCV-positive patients had hepatomegaly with an average increase in liver size of 4.17 and 4.33 cm, respectively. Splenomegaly was observed in 64.9% and 67.12% of HBV- and HCV-positive patients with an average increase in spleen size of 4 and 4.46 cm, respectively. Splenectomy was observed among 14.50% and 15.75% of HBV- and HCV-infected thalassemia patients. There is a strong need to properly screen blood before transfusions to reduce the future load of viral hepatitis from Pakistan.
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Affiliation(s)
- Umar Saeed
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Yasir Waheed
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology (NUST), Islamabad, Pakistan
- Foundation University Medical College, Foundation University Islamabad, DHA Phase I, Islamabad, Pakistan
- CORRESPONDENCE:
| | - Muhammad Ashraf
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Usman Waheed
- Safe Blood Transfusion Programme, Ministry of National Health Services, Government of Pakistan
| | - Sadia Anjum
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Muhammad Sohail Afzal
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology (NUST), Islamabad, Pakistan
- Department of Chemistry, School of Sciences, University of Management and Technology (UMT), Lahore, Pakistan
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Afzal MS, Khan MY, Ammar M, Anjum S, Zaidi NUSS. Diagnostically untypable hepatitis C virus variants: It is time to resolve the problem. World J Gastroenterol 2014; 20:17690-17692. [PMID: 25516688 PMCID: PMC4265635 DOI: 10.3748/wjg.v20.i46.17690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/10/2014] [Accepted: 09/16/2014] [Indexed: 02/06/2023] Open
Abstract
Pakistan is a low income country with more than 10 million hepatitis C virus (HCV) infections and the burden is on continuous raise. Accurate viral genotyping is very critical for proper treatment of the infected individuals as the sustained virological response of the standard antiviral interferon therapy is genotype dependent. We observed at our diagnostic center that 15.6% of HCV patient’s samples were not genotype-able by using Ohno et al method. The genotyped samples showed that 3a (68.3%) is the major prevalent genotype in Pakistan followed by 2a (10.3%), 3b (2.6%), 1b (1.5%), 2b (1.2%) and 1a (0.5%). Presence of large number of untypable HCV variants in the current study highlights an important issue of health care setup in Pakistan. Untypable HCV cases create difficulties in treatment of these patients. The problem of routine diagnostics setup of Pakistan should be addressed on priority basis to facilitate the medical professionals in patient’s treatment and to help in achieving the maximum sustained virological response.
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12
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Attaullah S, Khan S, Khan J. Trend of transfusion transmitted infections frequency in blood donors: provide a road map for its prevention and control. J Transl Med 2012; 10:20. [PMID: 22293125 PMCID: PMC3286364 DOI: 10.1186/1479-5876-10-20] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 01/31/2012] [Indexed: 12/17/2022] Open
Abstract
Background Transfusion transmitted infections create significant burden on health care system. Donor selection is of paramount importance because infected individuals serve as an asymptomatic reservoir and a potential source of transmission. Methods A retrospective study was carried out in healthy blood donors in the Lady Reading Hospital Peshawar, Pakistan over a period of three and a half years i.e., from January 2008 to June 2011, to determine the prevalence of HBV, HCV, HIV and syphilis in order to provide information for relevant polices. Results Out of 1,27,828 sample of blood donors, recorded mean prevalence for HBs Ag, anti-HCV, anti-HIV and syphilis was 2.68%, 2.46%, 0.06% and 0.43%, respectively, with an increasing trend in frequencies of transfusion transmitted infections (TTIs). Conclusions This study reflects that blood transfusion is one of the leading risk factor of spread of the TTIs, which showed the need and importance of the mandatory screening of these infectious markers in blood donations.
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Affiliation(s)
- Sobia Attaullah
- Department of Zoology, Islamia College Peshawar (A Public Sector University), University Campus, Jamrod Road, Peshawar 25120, Khyber Pakhtunkhwa, Pakistan.
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Attaullah S, Khan S, Ali I. Hepatitis C virus genotypes in Pakistan: a systemic review. Virol J 2011; 8:433. [PMID: 21902822 PMCID: PMC3178528 DOI: 10.1186/1743-422x-8-433] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/08/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIM Phylogenetic analysis has led to the classification of hepatitis C virus (HCV) into 1-6 major genotypes. HCV genotypes have different biological properties, clinical outcome and response to antiviral treatment and provide important clues for studying the epidemiology, transmission and pathogenesis. This article deepens the current molecular information about the geographical distribution of HCV genotypes and subgenotypes in population of four provinces of Pakistan. 34 published papers (1996-2011) related to prevalence of HCV genotypes/serotypes and subgenotypes in Pakistan were searched. RESULT HCV genotype/s distribution from all 34 studies was observed in 28,400 HCV infected individuals in the following pattern: 1,999 (7.03%) cases of genotype 1; 1,085 (3.81%) cases of genotype 2; 22,429 (78.96%) cases of genotype 3; 453 (1.59%) cases of genotype 4; 29 (0.10%) cases of genotype 5; 37 (0.13%) cases of genotype 6; 1,429 (5.03%) cases of mixed genotypes, and 939 (3.30%) cases of untypeable genotypes. Overall, genotype 3a was the predominant genotype with a rate of 55.10%, followed by genotype 1a, 3b and mixed genotype with a rate of 10.25%, 8.20%, and 5.08%, respectively; and genotypes 4, 5 and 6 were rare. Genotype 3 occurred predominately in all the provinces of Pakistan. Second more frequently genotype was genotype 1 in Punjab province and untypeable genotypes in Sindh, Khyber Pakhtunkhwa and Balochistan provinces.
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Affiliation(s)
- Sobia Attaullah
- Department of Zoology, Islamia College (Public Sector University) Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sanaullah Khan
- Kohat University of Science and Technology, Kohat Khyber Pakhtunkhwa, Pakistan
| | - Ijaz Ali
- Institution of Biotechnology and Genetic Engineering, KPK Agricultural University Peshawar, Pakistan
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Khan F, Shams S, Qureshi ID, Israr M, Khan H, Sarwar MT, Ilyas M. Hepatitis B virus infection among different sex and age groups in Pakistani Punjab. Virol J 2011; 8:225. [PMID: 21569532 PMCID: PMC3118204 DOI: 10.1186/1743-422x-8-225] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 05/13/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a serious health problem in the developing countries including Pakistan. Various risk factors are responsible for the spread of this infectious disease. Prevalence of HBV infection in apparently suspected individual of Punjab province of Pakistan was analyzed during January 2008 to December 2010. Current study was aimed to investigate the epidemiology and risk factors of HBV infection. METHODOLOGY Four thousand eight hundred and ninety patients suffering from chronic liver disease were screened for the presence of HBV DNA using qualitative Real Time PCR methodology to confirm their status of infection. A predesigned standard questionnaire was filled for all the patients that included information about the possible risk factors. RESULTS A total of 4890 ELISA positive patients were screened for Hepatitis B virus infection. Of these 3143 were positive for HBV, includes 68.15% males and 31.85% females. Male were observed to be more frequently infected as compared to the female with a positivity ratio of 2.14: 1. The rate of infection increases with the passage of time in the course of three years. Highest frequency of infection was found in the age of 21-30 was 34.93% followed by 23.83% in 31-40. Only (13.39%) were belonging to the age group 11-20 year. The rate of infection declines with increasing age as shown by age groups 41-50 (16.13%) and 51-60 (7.09%). While children aged 0-10 and very old >60 age groups were very less frequently 1.49% and 1.65% infected respectively. Important risk factors contributing to HBV spread include barber risk (23.60%), blood transfusion (4.04%), History of injection 26.19%, Reuse of syringes 26.60%, dental risk (11.20%) and surgical procedure (4.26%). Among the entire respondents trend sharing personal items was very common. History of injection, barber risk, surgery and dental procedure and reuse of syringes appear as major risk factors for the transmission. CONCLUSION Male were more frequently exposed to the risk factors as compared to female. Similarly the younger age group had high rate of infection as compared to the children's and the older age groups. Reuse of syringes', barber risk and History of injection were main risk identified during the present study. To lower HBV transmission rate Government should take aggressive steps towards massive awareness and vaccination programs to decrease the burden of HBV from the Punjab province of Pakistan.
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Affiliation(s)
- Fawad Khan
- Test Care Diagnostic lab, Lahore, Pakistan.
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Ali M, Idrees M, Ali L, Hussain A, Ur Rehman I, Saleem S, Afzal S, Butt S. Hepatitis B virus in Pakistan: a systematic review of prevalence, risk factors, awareness status and genotypes. Virol J 2011; 8:102. [PMID: 21375760 PMCID: PMC3058090 DOI: 10.1186/1743-422x-8-102] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/06/2011] [Indexed: 12/13/2022] Open
Abstract
In Pakistan, there are estimated 7-9 million carriers of hepatitis B virus (HBV) with a carrier rate of 3-5%. This article reviews the available literature about the prevalence, risk factors, awareness status and genotypes of the HBV in Pakistan by using key words; HBV prevalence, risk factors, awareness status and genotypes in Pakistani population in PubMed, PakMediNet, Directory of Open Access Journals (DOAJ) and Google Scholar. One hundred and six different studies published from 1998 to 2010 were included in this study. Weighted mean and standard deviation were determined for each population group. The percentage of hepatitis B virus infection in general population was 4.3318% ± 1.644%, healthy blood donors (3.93% ± 1.58%), military recruits (4.276% ± 1.646%), healthcare persons (3.25% ± 1.202%), pregnant women (5.872% ± 4.984), prisoners (5.75% ± 0.212%), surgical patients (7.397% ± 2.012%), patients with cirrhosis (28.87% ± 11.90%), patients with HCC (22% ± 2.645%), patients with hepatitis (15.896% ± 14.824%), patients with liver diseases (27.54% ± 6.385%), multiple transfused patients (6.223% ± 2.121%), opthalmic patients (3.89% ± 1.004%) and users of injectable drugs (14.95% ± 10.536%). Genotype D (63.71%) is the most prevalent genotype in Pakistani population. Mass vaccination and awareness programs should be initiated on urgent basis especially in populations with HBV infection rates of more than 5%.
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Affiliation(s)
- Muhammad Ali
- Division of Molecular Virology, National Centre of Excellence in Molecular Biology, University of the Punjab, 87-West Canal Bank Road, Thokar Niaz Baig, Lahore, Pakistan
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Ali L, Idrees M, Ali M, Rehman IU, Hussain A, Afzal S, Butt S, Saleem S, Munir S, Badar S. An overview of treatment response rates to various anti-viral drugs in Pakistani hepatitis B virus infected patients. Virol J 2011; 8:20. [PMID: 21235813 PMCID: PMC3027132 DOI: 10.1186/1743-422x-8-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 01/15/2011] [Indexed: 12/12/2022] Open
Abstract
Hepatitis B virus (HBV) is one of the leading health problem with up to 350 million affected people worldwide including 4.5 million only in Pakistan. It has mortality rate of 0.5 to 1.2 million per year worldwide. Pakistan lies in the endemic region with 3-5% HBV carrier rate in the country. The present article reviews the literature on the treatment response of HBV prevalent in Pakistani population. The average treatment response of Lamivudine and interferon-α is 25.81% and 47.95%, respectively. Peg-Interferon was shown to be not effective against the HBV/HCV (hepatitis C virus)/HDV (hepatitis Delta virus) co-infection. The present study reveals that interferon-α is the most effective therapy available for HBV infection prevalent in Pakistani population. Genotype C & D are the most common HBV genotypes in Pakistan and are associated with increased severity and less response to interferon therapy. This poses a great challenge for physicians and researchers and further studies are needed to describe the outcome of the current therapies recommended against HBV infection in Pakistani population.
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Affiliation(s)
- Liaqat Ali
- Division of Molecular Virology, National Centre of Excellence in Molecular Biology, University of the Punjab, 87-West Canal Bank Road, Thoker Niaz Baig, Lahore 53700, Pakistan.
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Umar M, Bushra HT, Ahmad M, Data A, Ahmad M, Khurram M, Usman S, Arif M, Adam T, Minhas Z, Arif A, Naeem A, Ejaz K, Butt Z, Bilal M. Hepatitis C in Pakistan: a review of available data. HEPATITIS MONTHLY 2010; 10:205-14. [PMID: 22308140 PMCID: PMC3269085 DOI: pmid/22308140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 02/22/2010] [Accepted: 03/03/2010] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV) infection is increasingly recognized as a major health care problem, and is found frequently in Pakistani settings. In this article we reviewed published and unpublished data related to the seroepidemiology of HCV infection in Pakistan. For this article, data from 132 published studies and three unpublished data sets published/ presented between the period 1992-2008 were utilized. Data of 1,183,329 individuals were gathered. Blood donors (982,481) and the general population (178,322) constituted the majority of these subjects. The frequency of HCV infection in blood donors and in the general population was 3.0 % (95% CI: 3.0- 3.1) and 4.7 (95% CI: 4.6 -4.8), respectively. The frequency among 6,148 pregnant females was 7.3% (95% CI = 6.7 - 8.0). The frequency in healthy children ranged from 0.4 to 4.1% (95% CI = 1.4 - 2.3). Pakistani HCV serofrequency figures are significantly higher (P < 0.0001) compared to those of the corresponding populations in surrounding countries like India, Nepal, Myanmar, Iran and Afghanistan.
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Affiliation(s)
- Muhammad Umar
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan,Corresponding author at: Muhammad Umar, M.B.B.S., F.C.P.S., F.R.C.P. Professor of Medicine, Rawalpindi Medical College, 965-B, Saidpur Road, Satellite Town, Rawalpindi, Pakistan. Tel.: +92514414174, Fax: +92514427614, E-mail:
| | - Hamama tul Bushra
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Masood Ahmad
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Available Data
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Masood Ahmad
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Muhammad Khurram
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Saima Usman
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Mohammad Arif
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Tashfeen Adam
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Zahid Minhas
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Adnan Arif
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Abdul Naeem
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Khushnud Ejaz
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Zameer Butt
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
| | - Muhammad Bilal
- Department of Medicine, Rawalpindi Medical College, Holy Family Hospital, Rawalpindi, Pakistan
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Waheed Y, Shafi T, Safi SZ, Qadri I. Hepatitis C virus in Pakistan: a systematic review of prevalence, genotypes and risk factors. World J Gastroenterol 2009; 15:5647-53. [PMID: 19960560 PMCID: PMC2789216 DOI: 10.3748/wjg.15.5647] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In Pakistan more than 10 million people are living with Hepatitis C virus (HCV), with high morbidity and mortality. This article reviews the prevalence, genotypes and factors associated with HCV infection in the Pakistani population. A literature search was performed by using the keywords; HCV prevalence, genotypes and risk factors in a Pakistani population, in Pubmed, PakMediNet and Google scholar. Ninety-one different studies dating from 1994 to May 2009 were included in this study, and weighted mean and standard error of each population group was calculated. Percentage prevalence of HCV was 4.95% +/- 0.53% in the general adult population, 1.72% +/- 0.24% in the pediatric population and 3.64% +/- 0.31% in a young population applying for recruitment, whereas a very high 57% +/- 17.7% prevalence was observed in injecting drug users and 48.67% +/- 1.75% in a multi-transfused population. Most prevalent genotype of HCV was 3a. HCV prevalence was moderate in the general population but very high in injecting drug users and multi-transfused populations. This data suggests that the major contributing factors towards increased HCV prevalence include unchecked blood transfusions and reuse of injection syringes. Awareness programs are required to decrease the future burden of HCV in the Pakistani population.
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Affiliation(s)
- Yasir Waheed
- NUST Center of Virology and Immunology, National University of Sciences & Technology, Sector H-12 Islamabad, Pakistan.
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