Harfouche Manale, Chemaitelly Hiam, Kouyoumjian Silva P, Mahmud Sarwat, Chaabna Karima, Al-Kanaani Zaina, Abu-Raddad Laith J
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
Department of Healthcare Policy & Research, Weill Cornell Medicine, Cornell University, New York, United States of America.
PLoS One. 2017 Oct 31;12(10):e0187177. doi: 10.1371/journal.pone.0187177. eCollection 2017.
To estimate hepatitis C virus (HCV) viremic rate, defined as the proportion of HCV chronically infected individuals out of all ever infected individuals, in the Middle East and North Africa (MENA).
Sources of data were systematically-gathered and standardized databases of the MENA HCV Epidemiology Synthesis Project. Meta-analyses were conducted using DerSimonian-Laird random-effects models to determine pooled HCV viremic rate by risk population or subpopulation, country/subregion, sex, and study sampling method. Random-effects meta-regressions were conducted to identify predictors of higher viremic rate.
Analyses were conducted on 178 measures for HCV viremic rate among 19,593 HCV antibody positive individuals. In the MENA region, the overall pooled mean viremic rate was 67.6% (95% CI: 64.9-70.3%). Across risk populations, the pooled mean rate ranged between 57.4% (95% CI: 49.4-65.2%) in people who inject drugs, and 75.5% (95% CI: 61.0-87.6%) in populations with liver-related conditions. Across countries/subregions, the pooled mean rate ranged between 62.1% (95% CI: 50.0-72.7%) and 70.4% (95% CI: 65.5-75.1%). Similar pooled estimates were further observed by risk subpopulation, sex, and sampling method. None of the hypothesized population-level predictors of higher viremic rate were statistically significant.
Two-thirds of HCV antibody positive individuals in MENA are chronically infected. Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex. HCV viremic rate is a useful indicator to track the progress in (and coverage of) HCV treatment programs towards the set target of HCV elimination by 2030.
估算中东和北非地区丙型肝炎病毒（HCV）病毒血症率，即慢性感染HCV个体在所有曾感染个体中所占比例。
数据来源为中东和北非HCV流行病学综合项目经系统收集和标准化的数据库。采用DerSimonian-Laird随机效应模型进行荟萃分析，以确定按风险人群或亚人群、国家/次区域、性别和研究抽样方法划分的合并HCV病毒血症率。进行随机效应荟萃回归以确定病毒血症率较高的预测因素。
对19593例HCV抗体阳性个体的178项HCV病毒血症率测量值进行了分析。在中东和北非地区，总体合并平均病毒血症率为67.6%（95%置信区间：64.9 - 70.3%）。在不同风险人群中，合并平均率在注射毒品者的57.4%（95%置信区间：49.4 - 65.2%）至患有肝脏相关疾病人群的75.5%（95%置信区间：61.0 - 87.6%）之间。在不同国家/次区域，合并平均率在62.1%（95%置信区间：50.0 - 72.7%）至70.4%（95%置信区间：65.5 - 75.1%）之间。按风险亚人群、性别和抽样方法进一步观察到类似的合并估计值。较高病毒血症率的假设人群水平预测因素均无统计学意义。
中东和北非地区三分之二的HCV抗体阳性个体为慢性感染。尽管HCV病毒血症率的研究特定测量值存在广泛差异，但无论风险人群或亚人群、国家/次区域、背景人群中的HCV抗体流行率或性别如何，合并平均估计值相似。HCV病毒血症率是追踪HCV治疗项目朝着2030年消除HCV既定目标进展（和覆盖范围）的有用指标。
