Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1684-1700
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1684
Hepatitis C virus prevalence and genotype distribution in Pakistan: Comprehensive review of recent data
Muhammad Umer, Mazhar Iqbal
Muhammad Umer, Mazhar Iqbal, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering, Faisalabad 38000, Pakistan
Author contributions: Umer M conducted literature search and contributed in manuscript preparation; Iqbal M carried out the data analysis and wrote the manuscript.
Supported by Higher Education Commission of Pakistan, through Grant No. 20-2056 to Iqbal M.
Conflict-of-interest statement: Authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mazhar Iqbal, PhD, Principal Scientist, Group Leader, Drug Discovery and Structural Biology Group, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering, Faisalabad 38000, Pakistan.
Telephone: +92-41-9201403 Fax: +92-41-2651472
Received: April 28, 2015
Peer-review started: May 7, 2015
First decision: September 9, 2015
Revised: October 11, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: January 28, 2016

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.

Keywords: Hepatitis C, Pakistan, Hepatitis C virus, Liver cancer, Hepatitis C virus genotypes, Epidemiology

Core tip: Hepatitis C virus (HCV) in Pakistan is highly endemic, with around 6.8% of general population infected with this virus. Approximately 6% of the population of Pakistan is actively infected with HCV. However, only very few relevant reports are available and more studies are needed. Research articles reviewed suggest a link between underdevelopment and HCV prevalence, as well as the predominant involvement of unsafe medical procedures in the spread of the virus in Pakistan. Although genotype 3a is most prevalent HCV subtype in Pakistan, recent years have witnessed an increase in the incidence of genotype 2a in Sindh and Khyber Pakhtunkhwa provinces.